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