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HomeMy WebLinkAboutPension General_Documentation_Tab 06_08/07/2006 ILLAGE OF TEQUESTA • GENERAL EMPLOYEES PENSION TRUST FUND ENROLLMENT AND BENEFICIARY DESIGNATION FORM I, 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: C~~s Address: (- 4'~ ~ ~ e ~ b ti ti¢. (~.J..,~ ~ C O Z 1P ~ Fr -F(. 33 ~ I ~ Date of Birth: t l 14- S `Z Date of Employment: I ~, ~ Primary Beneficiary: Address: Contingent Beneficiary(ies): Address: The right is reserved to revc designate a new beneficiary. Zve Relationship: SO~J is designation and subject to due notice to the Trustee to ~~ G1-3~-~°lr~ Date Signed Signature of Participant • Date Witnessed Signature of Witness: Plan Official Or Notary Public Krb/word/forms/EPTFgeneralemployeeben~ciarydesignation Social Security Number VILLAGE OF TEQUESTA GENERAL EMPLOYEES PENSION TRUST FUND a ENROLLMENT AND BENEFICIARY DESIGNATION FORM • I, ~ ~,, e, ~ ~~ ~ ~ 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: ~ ~, ~ 1 Address:_ _ ~ _~i~ ~'~~'~Ul~-~'`~% L.~R Date of Birth: .`~~ ~-~ ~ ~ ~:. Date of Employment: ~ ~~-~.~ .-(? ~r Primary Beneficiary: Relationship: Address: Contingent Beneficiary(ies): ~ ~ S ~ r~ ~ r~ `~ Address: ~ ~ ~ `~ ~ ~ ~%~. ~, ~,~ 1~~r ~ : L.,r-~ - - ~, ~ C:a..~ n N j The right is reserved to revoke this designation and subject to due notice to the Trustee to designate a new beneficiary. .; r? Date Signed ~ ?Signature of Participant Social Security Number • Date Witnessed _ Signature of Witness: Plan Official Or Notary Public Krti/word/forms/EPTFgeneralemployeebeneficiarydesignation VII,LAGE OF TEQUESTA GENERAL EMPLOYEES PENSION TRUST FUND ENROLLMENT AND BENEFICIARY DESIGNATION FORM I, ~ n DDAiA/E ~'. ~f~i A/~ , do hereby request to participate in the General Employees' Pension Trust Fund of the Village of Tequesta on the date ias 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 employmern, I herby designate the following Beneficiary(ies) to receive my death benefit from the Plan: Name of Participant: Address:n1~G D ~ • D Gf'~al ~~ ~ ~~~ ~~Ns~~ ~~~~~ ~~ 3~`9~'~ Date of Birth: ,a a?3 ` ~- Date of Employment: ~ ~ d,~ Primary Beneficiary: ~s1/~onY ~• r~~~N~ Relationship:. ~ Address: 7~,7DD ~S GCF~~ ~~- ~aoo .~-- ~~~~~~ ~~~ ~~ ~ X9..5',? Contingern Beneficiary(ies): Address: ~Q.Yx-~ ~ ~o /~ The right is reserved to revoke this designation and subject to due notice to the Trustee to designate a new beneficiary. Signature of Participant S a~-° 6 ~~ Date Witnessed Signature of Witness: Plan Official Or Notary Public SocialSecurity Number ~r~rrF~a.~~ioy~~r-a.rya~~~ VILLAGE OF TEQUESTA GENERAL EMPLOYEES PENSION TRUST FUND ENROLLMENT AND BENEFICIARY DESIGNATION FORM;: I, ~~ ~~- f~~l f7 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 terns 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: - ~ GC/ Date of Employment: ~j "^ ~- 2~~ Primary Beneficiary: ~i11 ! Relationship: • Address: 1 ~I ~~ ~ ~ ~~~,~~~ ~~ ~~~~I~/(~~i~, ~ ~3~ i 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 Social Security Number Date Witnessed Signature of Witness: Plan Official Or Notary Public 3~a ~~ Krb/wad/fates/EPTFgaietalemployoeba~eficiaryd~sig-ation VII.LAGE OF TEQUESTA GENERAL EMPLOYEES PENSION TRUST FUND ENROLLMENT AND BENEFICIARY DESIGNATION FORM • I, ~~/.f~`~~,(G•-~~~~e%,c,, 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: i Name of Participant: ~~ ~ ~~~ Address: ~~~~/ S~~ /~Ah~6~, ~c l_~ ~~~~ vL ~G 'I Date of Birth: 3-~a -~~ Date of Employment:. (~ -lam :~ - Primary Beneficiary:~~~s°~,i,,c S,~ssr' Relationship: ~f-~ Address: ~~-`~ ~~ ~1 ~ h~rw~- Crz f~o~~ ~ ~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. (1l ~~ `© c1? ~~.i't~ltl~ .YJ~o7~1'..~~,.~.-~. ~l fS~ 7 .fr cc~ ~1 S3 Date Signed Signature of Participant Social Security Number • Date Witnessed Signature of Witness: Plan Official Or Notary Public x~aa~e~rrFg~~~~ia~a~a~~~,~;«~