DESIGNATION OF BENEFICIARY
If the Board of Directors approves my application for early retirement benefits and I die before I receive the cash payment provided by the Early Retirement Plan, I direct the Board of Directors to make the payment to:
_____________________________________________________________________________
(Print Full Name of Beneficiary)
Print Full Name of Employee _____________________________________________________
____________________________________________ ________________
Employee Signature Date
Revised: 12/13 Reviewed: 04/14
