HomeMy WebLinkAboutPension General_Documentation_Tab 07_02/04/2008VII.LAGE OF TEQUESTA
• GENERAL EMPLOYEES PENSION TRUST FUND
ENROLLMENT AND BENEFICIARY DESIGNATION FORM
•
I, ,~,.,,~ ~,Q„ ~,.,~ do hereby request to participate in the General
Employees' Pension T t 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 terms and
conditions of the Plan as provided to me and agree to the terms and conditions of the
Plan.
In the event of my death prior to termination of employment, I hereby designate the
.following Beneficiary(ies) to receive. my death benefit from the Plan:
Name of Participant:
,~,
Address: ;~';'r' ~ '~a<,~t~~- fir'
,~
Date of Birth: =~~'/i Date of Employment: tom; ~ a,,~?~
Primary Beneficiary: ~~=~a~.:.,r,. ~"y~_.: g,,, ~,~ .Relationship: ~ fa..,_,-.
Address: '?`3 ~ :~ a ~'~. r .: ,~
-~ ~--:
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.
Signed v Signature of
• Date Witnessed Signature of Witness: Plan Official
Or Notary Public
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Social Security Number
•
•
VII~LAGE OF TEQUESTA
GENERAL EMPLOYEES PENSION TRUST FUND
ENROLLMENT AND BENEFICIARY DESIGNATION FORM
.--
I, ~ C~ C ~ L'?C;~C,"7~.t ~~~~~r-i/! , do hereby request to participate in .the General
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 terms and
conditions of the Plan as provided to me and agee to the terms and conditions of the
Plan.
In the event of my death prior to .termination of employment, I hereby designate the
.following Beneficiary(ies} to receive. my death benefit from the Plan:
Name of Participant: ~! ~ ~' ,fir 6') ~(~ i G~ .~ C~ Z~'iL-°'J
r
Address: 1 ~'? ~ I ';~,'~'"~ ~ ~~ ~-~ ~U!~~t>'' ~iJr
Date of Birth: '~'~' U~ ~' ~ Date of Employment: ~ / /~ ~ (~~? r'
Primary Beneficiary: C~i C C 1 ~ ~"i ~V ~ G'ht~ '. elationship: 1,15 -~` ~ti Y~ CJ
~~~
Address: ! ~"' ~:;' 1 ~ C~., ~'~ i Y? C' ~ ~ ~'~'t~ 'r~'
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.
Da a Signed Signature of Participant Social Security Number
.~ ~- ~~ .~
• Date Witnessed Signature of Witness: Plan Official
Or Notary Public
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VII.LAGE OF TEQUESTA
• GENERAL EMPLOYEES PENSION TRUST FUND
ENROLLMENT AND BENEFICIARY DESIGNATION FORM
I, ~~ ~~ ~ ~ a~~ do hereby request to participate in the General
Employee 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 terms and
conditions of the Plan as provided to me and agree to the terms and conditions of the
Plan.
In the event of my death prior to .termination of employment, I hereby designate the
.following Beneficiary(ies) to receive. my death benefit from the Plan:
Name of Participant:
Address:
~'~ ~ ~ ~ •
Date of Birth: ~~~ ~~.~;-~`;~ ~ Date of Employment: ~ ~:~~ ~'~~ °,~
Primary Beneficiary:_~~4^~;• y,~, ~„~ ~~ex~ ,~;~~ Relationship:
Address: '•~~~~' "7~=- 1=/~Ba~ ~~e~'~_~-~~~ , o"~'~~ ~ ~>,,.~.;~ y=_~
,--
_~ ~`
Contingent Beneficiary(ies): ~~,~~:=.~.`:~1;:, ~~. ~n;~
Address: ~-~ ~ a ~~ ...~ ~ ~'~~~. ~ ~~;~ ~ ~,~, ,~~.~ ~3 ~.~ ; .`~d . ~'`~
-~
~~
The right is reserved to revoke this designation and subject to due notice to the Trustee to
designate a new beneficiary.
o~~~~ ~~~
Date Signed
of Participant
1; J ^~ ~ y ~-~*,
• Date Witnessed Signature of Witness: Plan Official
Or Notary Public
Social Security Number
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~J
•
VIg.I.AGE OF TEQUESTA
GEI~ERAI., EIi~I..®YEES PEZi1SIO1~T 'I'RiTST FIJIVD
El~t><2®I.I.IVIEl~1'I' AIVD BENEFICIARX DESIGI~A'I'IOIV F®Rft~I
I, ir~ ~1,C~:51~'r~ ~`" - ~/~6- ~~L~~1, s do hereby request to participate in the General
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 terms and
conditions of the Plan as provided to me and agree to the terms and conditions of the
Plan.
In the event of my death prior to termination of employment, I hereby designate the
following Beneficiary(ies) to receive. my death benefit from the Plan:
Name of Participant: - _lt~,l'~-5,%~~/ ~ /~'~y'~-,-, ~,~~ x;
Address: ;5~30:~ ~~ t~J .~~ I'~'JGr~ ~.n L'~"
r ~~~Tr .~~j • ~i~ci~ ~ ~/ 3 ~1vra'~
Date of Birth: Of ° /~' - :~''~~ Date of Employment: j ._ .~ ,3., _ ~l ~%
Primary Beneficiary: U,
Relationship:
Address: ~ ~l_~G~, /~~ l.~ 17~~'I~//~1~~ f~ I~t~~
Contingent Beneficiary(ies): IC ~11`f ~~ ~? :. _. ~ ~ ~
Address: r~ f. ~~ ~ ~ l~L'~ /~~a~ ~~ .~ .
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 t Social Security Number
• Date Witnessed Signature of Witness: Plan Official
Or Notary Public
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~.I.AGE ®F 'I'EQIJES'I'A
• GEI`TEItAI, EMPLOYEES PE1o1SI®1~1 TItIJS'I' FITti1I)
EIVIt®LLMEIVT' Alm BENEFICIA~itl' DESIGI`T,~1TIO1V F®R1VI
•
~.
I~ 61 ' h
do hereby request to participate in the General
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 terms and
conditions of the Plan as provided to me and agree to the terms and conditions of the
Plan.
In the event of my death prior to termination of employment, I hereby designate the
following Beneficiary(ies} to receive. my death benefit from the Plan:
Name of Participant:
Address:
Date of Birth: ~~~' `~°~. ~~ '~a~:~
~, '~~~-~
DateofEmployment: ~~& ~ ' '~~
Primary Beneficiary: ~" ~ ~%' ~ ~. z~g~, ' ~~' ~,;r' Relationship: ~ '
Address: ~'?'"t`~`., U '~ ~-~'
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. z
~ L
Dat Signed
Signature of Participant
Social Security Number
Date Witnessed Signature of Witness: Plan Official
Or Notary Public
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