407.6E3 Designation of Beneficiary

Code No 407.6E3

DESIGNATION OF BENEFICIARY

If the Board approves my application for early retirement assistance benefits and I die before I receive payment of all of the benefits described in the voluntary early retirement assistance plan, as applicable, I direct the Board to pay the remaining benefits to: _____________________________________________.
             (Name of Beneficiary)

Print Full Name _________________________________________________

Signed ___________________________________ Date _________________

 

Approved: 11/9/16

Reviewed: 12/14/22

Grinnell-Newburg Community School District, Grinnell, Iowa