413.2E3 Designation of Beneficiary

Code No 413.2E3

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: 12/14/2022

Grinnell-Newburg Community School District, Grinnell, IA