HomeMy WebLinkAboutDocumentation_Pension General_Tab 04a_04/28/19991 F
New entrants into Pension Plan
Name Hire Date
Neil DiRico 2/17/99
Cynthia Sementelli 2/22/99
Rocco Napoli 03/09/99
Mark Spurgeon 03/31/99
Mark Fives 04/13/99
Payouts
Term Employee/
Name Date Total Rollover
Cheryl DeBlasio 01/15/99 1406.16 1406.16
Tracey Friscia 11/15/98 880.17 704.14
Paul Magnano 2/4/99 2042.50 2042.50
Robert Smith 2/26/99 8550.91 8550.91
Craig Speigelhalter 1/14/99 3168.11 2534.49
945 Tax
176.03
633.62
EMPLOYEES PENSION TRUST FUND OF THE VILLAGE OF TEQUESTA
ENROLLMENT AND BENEFICIARY DESIGNATION FORM
I, -,! --~ ! ~ ~ ~~ do hereby request to participate in the Employees Pension Trust
Fund of the Village of Tequesta on the date as of which I am eligible to begin participation under the
terms of the Plan. I understand the general provisions of the Plan as provided to me and agree to
the provisions of the Plsn. 1 /
__~-general employee v HreC titer
g police olHcer
In the event of my death prior to termination of employment. I hereby designate the following
Beneficiary(iea) to receive my death benefit tiom the Plan
Name of Participant:
Address:
Date of Birth:~~3~70
Date of Employment: 2 - /7. 99
Primary BeneSciary: ~~>~~Zr~ ~/ cry Relationship: _~
--.-
Address: /~ .G~ao,~ J ~~
~~4,2~~ ~.. ~~LOt t~i7 ~
Contingent Beneficiarq (ies) _C~wr~ ~~~ ~
Address: /~ S C~„~~~ ~'~ -
The right is reserved to revoke this designation and subject to due notice to the Trustee to designate
a new bene5ciary. ,
2 is - ~9 - ~'_~~c~'~-~~ O/~--6~/-~z ~'S
(Date Signed) ~ (Signature of Participant) (~~
(Date Witnessed) (Signature of Witness: Plan official
or Notary Public)
. ii
_!~~?~ ~ 7?a6 ~
08/09x96
EMPLOYEES PENSION TRUST FUND OF THE VILLAGE OF TEQU'ESTA
ENROLLMENT AND BENEFICIARY DESIGNATION FORM
I, r ~ @~ ~! - do hereby request to participate in the Employees Pension Trust
Fund of the Village of Tequesta on the date se of which I am eligible to begin participation under the
terms of the Plan. I understand the genera! provisions of the Plan as provided to me and agree to
the provisions of the Plan.
~.geaeral employee ~*eHghter lice officer
In the event of my death prior to termination of employment, I hereby designate the following
Beneiiciary(ies) to receive my death benefit from the Plan
Name of Participant:
Date of Birth:
Date of Employment:
. ~ <<
Pcimary Beneficiary: ~1 e/ ~ Belatiooship:(
Address: ~~~~~ J ~ ~L~~~
r
~1 ~~~~
Contingent Beneficiary (ies)
I Address:
The right is reserved to revoke this designation and subject to due notice to the Trustee to designate
a new beneficiary.
(Date Signed) ~~` ~1~0
zgnature of P ' 'pant) (~~
Z,2 3-~ ~
~_p--~.... ~ v. .. awaceo. r uaa~vauCaBd
or Notary Public)
e
FYI
EMPLOYEES PENSION TRUST FUND OF THE VILLAGE OF TEQUESTA
ENROLLMENT AND BENEFICIARY DESIGNATION FORM
I, ~.~ ~C y_ ~ N a ~ ~ 1512 do hereby request to particspate is the Employees Pension 'l~uat
Fund of the Village of Tequesta on the date as of which I am eligible to begin participation under the
terms of the Plan. I understand the general proviaioas of the Plan as provided to me and agree to
the proviaion8 of the Plaa.
_eaeral employee firefighter police otYlcer
In the event of my death prior to termination of employment, I hereby designate the following
Beaeficiary(ies} to receive my death bene5t from the plan .
Name of Participant: ~o CCO ~ 1 ~ pU~ i
Address:
Date of
Date of Empbymeat:
Primary Beneficiary: ~p.C!`Y~ ~,~I~_ Re4tioasbip: ~lGk ~C ~
Address; (Q ~ (,~G~
In1~S+ Palm {~S,a~.~l ~!_._ ~~y ~ ~
. ,:
Contingent BeneRciary (ies) ~ t ~~ C ~ ~~O ~ 1
,, ,
Address: ~ U ~ ~ j;Cc L P
'° ~eec,~.c.i cc,~ S rv ~ 070 9y .
--
The right is reserved to revoke this desig~tion and subject to due notice to the Trustee to designate
a new beneficiary.
03 o z ~ ~ 135 7(0 -3fs~~
(Date Signed} (Signs of P "P (SSI~
t
(Date Witnessed) (Si tune of Wtne Plan`
f~ , official
or i~atary; Public)
~~ .
Im't 1~ (n 2 ~ Lt.3 of H _
EMPLOYEES PENSION TRUST FUND OF THE VILLAGE OF TEQUESTA
ENROLLMENT AND BENEFICIARY DESIGNATION FORM
I, _ ~ A R K R. 5 PvR C, fa „/ do hereby request to participate is the Employees Pension Trust
Fund of the Village of Tequesta on the date as of which I am eligible to begin participation under the
terms of the Plan. I understand the genera] provisions of the Plan as provided to me and agree to
the provisions bf the Plan.
General employee srefig6ter oalice ot8cer
In the event of my death prior to termination of employment. I hereby designate the following
Beneficiary(ies) to receive my death benefit firom the Plan
(Name of Participant: _M ARk (~. SPyR C ~rn.f
Address: R N 12 S~ (~,,,~ c ~N~ S t
Nuf~G 5ovn~n FL 33NSS
Date of Birth: D I ~ zo ~ 73 Date of Employment: 9
Primary Beneficiary: ~- Cg Yst~ ~ cSPvr' ~ 18elatioaship: w i F F
Address: _qN 12 SE O~,~cp,,,~ S~
~} o g~ So~ti~~ F C 33y ss
Contingent Beae6ciary (ies)
Address: -'
The righE is reserved to revoke this designation and subject to due notice to the Trustee to designate
a new beneficiary. .
0 9
(Date Signed)
oy-o~-~ ~
(Date Witnessed)
Z62 ~~1 ~S) 2S
(Si store of P icipant) (~~
(Signature of Witness: Plan offi al
or Notary Public)
f-
EMPLOYEES PENSION TRUST FUND OF THE VILLAGE OF TEQUESTA
ENROLLMENT AND BENEFICIARY DESIGNATION FORM
I, /!?~R/~ ~, ~it~5
do hereby request to participate in the Employees Pension Trust
Fund of the Village of Tequeata on the date as of which I am eligible to begin participation under the
terms of the Plan. I understand the general provisions of the Plan ae provided to me and agree to
the pmviaiona of the Plan.
_~eaeral employee SreBahter police ot8cer
In the event of my death prior to termination of employment. I hereby designate the following
Beneficiary(ies) to receive mq death benefit from the Plan
Name of Participant: _ i'J'ls~R,~ ~, ~/ v'e S
Address: YID ~/~f igg d~ `/ S ~ ~ Q~
l3~ y~,,. ~o,v ~c~ ,~L 3 3 ylr ~
Date of Birth: 3 "-3 / -Cr / Date of Employment- y' /3 - p9
Primary Beneficiary: ~4f~i41L ~1 j,yq Selatioaship: /~,~-~
Address: ye?D /?~tG~QOW S C/i2 C
/.3~1.vf•~ /3c~ ~ /eL 3 3 ylo ~
~ Contingent Beneficiary (ies)
(Address:
The right is reserved to revoke this designation and subject to due notice to the Trustee to designate
a new beneficiary.
(Date Signed) (Signature of Participant)
(Date Witnessed) (Signature of Witness: Plan ~cial
or Notary Public)
~G ?~7 ~f~
(SSN)