10
“All securities are offered for sale or purchase by First Financial Securities of America, Inc.” Dear Glen Rose ISD Employee, Right now, you have an opportunity to make a real difference in the future of your retirement. How? By joining the FFInvest 457(b) Plan! The Plan we offer is a valuable benefit to help you save for the future. Saving now can help you have the income you’ll need at retirement. Participating in the Plan is easy. You contribute a portion of your pay to your Plan account each payday through convenient payroll deduction. Contributions are then allocated to the Plan’s investment options you select. There are significant tax advantages, too. For example, if you elect pre-tax deductions, your qualifying contributions and all earnings on your account are not subject to current federal income tax (or, where applicable, state or local taxes) until you take them out of the Plan. This tax deferral gives your retirement savings ability to grow under the most favorable terms possible. Your district’s retirement plan also offers Roth (after-tax) deductions. By combining convenience with these special tax benefits, your retirement savings plan offers you one of the best ways to fund your future. You may contribute $19,000 or $25,000 annually if you are age 50 and over. We are excited to offer you this worthwhile benefit and we hope you will use it to help make your retirement dreams a reality. As with any investment, there are risks involved but FFInvest offers a wide range of choices that allow you to tailor your investments to match your risk tolerance. Get started today and take the first step toward a brighter future. More information may also be found online at http://ffinvest.my457account.com or http://benefits.ffga.com/glenroseisd and selecting “Benefits” and then “FFInvest 457(b)” under “Employer Programs.” Sincerely, Ryan Hancock Sr. Account Administrator Registered Representative First Financial Group of America Dallas Branch Office 1200 W. Walnut Hill Lane Ste. 3400 Irving, TX 75038 Office: 1-800-883-0007 Local: (469) 417-0505 Fax: (469) 417-0509 Email: [email protected]

Dear Glen Rose ISD Employee, - Glen Rose Independent ... › wp-content › uploads › 2019 › 11 › 457... · a portion of your pay to your Plan account each payday through convenient

  • Upload
    others

  • View
    1

  • Download
    0

Embed Size (px)

Citation preview

Page 1: Dear Glen Rose ISD Employee, - Glen Rose Independent ... › wp-content › uploads › 2019 › 11 › 457... · a portion of your pay to your Plan account each payday through convenient

“All securities are offered for sale or purchase by First Financial Securities of America, Inc.”

Dear Glen Rose ISD Employee,

Right now, you have an opportunity to make a real difference in the future of your retirement.

How? By joining the FFInvest 457(b) Plan!

The Plan we offer is a valuable benefit to help you save for the future. Saving now can help

you have the income you’ll need at retirement. Participating in the Plan is easy. You contribute

a portion of your pay to your Plan account each payday through convenient payroll deduction.

Contributions are then allocated to the Plan’s investment options you select.

There are significant tax advantages, too. For example, if you elect pre-tax deductions, your

qualifying contributions and all earnings on your account are not subject to current federal

income tax (or, where applicable, state or local taxes) until you take them out of the Plan. This

tax deferral gives your retirement savings ability to grow under the most favorable terms

possible. Your district’s retirement plan also offers Roth (after-tax) deductions. By combining

convenience with these special tax benefits, your retirement savings plan offers you one of

the best ways to fund your future.

You may contribute $19,000 or $25,000 annually if you are age 50 and over.

We are excited to offer you this worthwhile benefit and we hope you will use it to help make

your retirement dreams a reality. As with any investment, there are risks involved but FFInvest

offers a wide range of choices that allow you to tailor your investments to match your risk

tolerance. Get started today and take the first step toward a brighter future.

More information may also be found online at http://ffinvest.my457account.com or

http://benefits.ffga.com/glenroseisd and selecting “Benefits” and then “FFInvest 457(b)”

under “Employer Programs.”

Sincerely,

Ryan Hancock

Sr. Account Administrator

Registered Representative

First Financial Group of America

Dallas Branch Office

1200 W. Walnut Hill Lane Ste. 3400

Irving, TX 75038

Office: 1-800-883-0007

Local: (469) 417-0505

Fax: (469) 417-0509

Email: [email protected]

Page 2: Dear Glen Rose ISD Employee, - Glen Rose Independent ... › wp-content › uploads › 2019 › 11 › 457... · a portion of your pay to your Plan account each payday through convenient

We are excited to announce the FFInvest Retirement Plan that is now available. The FFInvest 457(b) Retirement Plan is a comprehensive plan funded by Net Asset Value Mutual Funds. It is a competitive & simple, yet flexible plan with a 401(k) type of approach.

Plan Highlights:• Multiple Investment Options

The plan provides 21 different investment options to take advantage of changing investment market conditions,including American Funds, Vanguard, Harbor, and Delaware. There are also Bond Funds and Target Date Retirement Funds to choose from.

• Roth (After-Tax) Deduction Option Available

• Rollovers/TransfersRollovers/Transfers are accepted into the plan from other retirement plans, including IRA’s

• Retirement Savings Contributions Credit (Saver’s Credit)An individual may be able to take a tax credit of up to $1,000 ($2,000 if filing jointly) for making eligiblecontributions to an employer-sponsored retirement plan.

• NO IRS PenaltyNO 10% IRS penalty for withdrawals prior to age 59 ½

• NO Front-End Sales ChargeThere are NO sales charges taken from contributions. This means that100% of all contributions are invested and start working for you.

• NO Deferred Sales Charge

• Client Friendly Technology & Communication» Quarterly Statement» Toll-free telephone number» Interactive website: www.my457account.com» Personalized Benefit Projections» Loan Option» Blog / Calculators» Quarterly Newsletter

Introducing...

FFInvest 457(b) Retirement Plan

For Questions or Information on how to enroll in the new FFInvest 457(b) Retirement Plan, please contact Ryan Hancock at [email protected]

$19,000 – under age 50

$25,000 – age 50 and over

Contribution Limits for 2019

IT IS VERY IMPORTANT THAT YOU READ AND UNDERSTAND THE FOLLOWING: All investments involve some degree of risk. The funds are offered by prospectus, which contains more complete information regarding the investment objectives, risks, charges

and expenses associated with an investment in the fund. Please be sure and review the prospectus before deciding to invest.

Enroll Online Now!» Go to www.my457account.com» Select "Retirement Plan Login"(upper left hand corner, above InvesTrust logo)» Select "New User"» Enter Plan Password (case sensitive): GlenRoseIf you have questions, please contact an InvesTrust Retirement Plan Specialist at 1-866-848-0258, Monday -Friday, 8:00 a.m. to 5:00 p.m. CST.

Page 3: Dear Glen Rose ISD Employee, - Glen Rose Independent ... › wp-content › uploads › 2019 › 11 › 457... · a portion of your pay to your Plan account each payday through convenient

This FAQ is designed to inform Participants about the Plan. Every attempt is made to convey the Plan accurately; however, if anything varies from the Plan Documents, the Plan Documents will prevail. Plan Administration Fees, Investment Options, etc. are subject to change without notice. This FAQ is not intended to convey legal or tax advice, nor can it be used to avoid the payment of income taxes or penalties assessed by any US tax authority.

Page 4: Dear Glen Rose ISD Employee, - Glen Rose Independent ... › wp-content › uploads › 2019 › 11 › 457... · a portion of your pay to your Plan account each payday through convenient

This FAQ is designed to inform Participants about the Plan. Every attempt is made to convey the Plan accurately; however, if anything varies from the Plan Documents, the Plan Documents will prevail. Plan Administration Fees, Investment Options, etc. are subject to change without notice. This FAQ is not intended to convey legal or tax advice, nor can it be used to avoid the payment of income taxes or penalties assessed by any US tax authority.

FAQ’S

Page 5: Dear Glen Rose ISD Employee, - Glen Rose Independent ... › wp-content › uploads › 2019 › 11 › 457... · a portion of your pay to your Plan account each payday through convenient

¹ Projections assume a marginal tax rate of 25%. ²Projections assume a 7% investment rate; this annual rate is not necessarily representative of the rate of return of any specific investment. The projection assumes payments made semi-monthly with no withdrawals nor loans and is only an example. The calculations provided should not be construed as financial, legal, or tax advice. ³TRS Pension Benefit Design Study 9/1/2012. All investments involve some degree of risk. Mutual funds are offered by prospectus, which contains more complete information regarding the investment objectives, risks, charges and expenses associated with an investment in the fund. Please be sure and review the prospectus before deciding to invest. For more information, please contact your First Financial Benefits Representative or visit http://ffinvest.my457account.com or http://benefits.ffga.com/glenroseisd/

Glen Rose ISD

HOME OF THE TIGERS

PO BOX 2129 Glen Rose, TX 76043-2129 | Phone: (254) 898-4000 | Fax: (254) 897-3651

November 15, 2019

Dear Glen Rose ISD Employee,

Glen Rose ISD is pleased to reintroduce the Defined Contribution Retirement Plan available for all

employees. The sooner you start to save, the more likely you are to reach your retirement goals. The

table below shows the amount you could have in your retirement account at age 65 based on the age

you start contributing.² This table clearly displays the potential benefits of participating in this valuable

employee benefit program.

Don’t Delay Saving for Retirement—The Sooner You Start, the Better.

Monthly Age 25 Age 35 Age 45 Age 55 Total Saved

Monthly Deferred Taxes

Monthly¹

Reduction In Take Home Pay

Monthly

$25 $66,003.12 $30,677.19 $13,099.13 $4,352.36 $25.00 $6.25 $18.75

$50 $132,006.24 $61,354.37 $26,198.27 $8,704.72 $50.00 $12.50 $37.50

$100 $264,012.48 $122,708.75 $52,396.54 $17,409.45 $100.00 $25.00 $75.00

$250 $660,031.20 $306,771.87 $130,991.35 $43,523.62 $250.00 $62.50 $187.50

$500 $1,320,062.40 $613,543.75 $261,982.70 $87,047.23 $500.00 $125.00 $375.00

$750 $1,980,093.61 $920,315.62 $392,974.05 $130,570.85 $750.00 $187.50 $562.50

$1,000 $2,640,124.81 $1,227,087.49 $523,965.40 $174,094.47 $1,000.00 $250.00 $750.00

You may contribute up to the maximum allowable contribution of $19,000 annually or $25,000 if you are

age 50 and above. This is the perfect opportunity to pay yourself FIRST! You also have the option of Roth

(after-tax) deductions. With today’s average life span being longer, you may find that your TRS

retirement funds may not be enough to meet your retirement needs. The average TRS pension benefit

replaces 68% of a career employee’s pre-retirement income³, an amount unlikely to support a

comfortable retirement. That’s why your retirement savings plan is one of the most valuable employee

benefits we provide. We urge you to seriously consider enrolling in the 457(b) Plan today!

If you are interested in starting a 457(b) Plan, please contact:

Ryan Hancock

Sr. Account Administrator

Registered Representative

Email: [email protected]

Page 6: Dear Glen Rose ISD Employee, - Glen Rose Independent ... › wp-content › uploads › 2019 › 11 › 457... · a portion of your pay to your Plan account each payday through convenient

1. Traditional pretax contributions – The amount you contribute comes out of your paycheck beforeincome tax is taken out. Your current income tax bill will be lower. No taxes are due on your contributions orearnings until you withdraw money from the plan.

2. Roth – Contributions are taken out of your paycheck after your income is taxed, which does not lower yourcurrent taxes.

Why would a Roth be to your advantage? Your contributions, and the earnings on them, are tax-free upon withdrawal in retirement. When you withdraw funds from your Roth account, you won’t pay taxes on any earnings, as long as certain tax law requirements are met. Withdrawals of Roth contributions are always tax-free since you have already paid taxes on the contributions.

Benefit Traditional Pretax Roth ContributionsTax-deferred Contributions? Yes NoTreatment of Plan Earnings? Tax Deferred Tax Free*Tax-free Distributions? No Yes**Tax law requirements must be met

Is Roth Retirement Savings For You?Your Plan offers two ways to gain tax benefits from your savings:

Should you pay taxes now or later?Generally, if you anticipate being in a higher tax bracket during retirement, you’ll benefit from making Roth contributions. If you think you’ll be in a lower tax bracket at retirement, pretax contributions may be the way to go.

Roth contributions are tracked and their records kept in a separate account, with any earnings and losses allocated to the Roth account. Similar to elective deferrals, they are 100 percent vested. Once you designate elective deferrals as Roth, they cannot be converted into pretax contributions. If you receive a matching contribution, your account will accept the funds, but the employer contributions will be made on a pretax basis. Therefore, you will owe income taxes on the employer matching contributions and any earnings upon withdrawal.

Roth Rollovers and DistributionsA distribution from a Roth account that is a qualified distribution is tax-free. A qualified distribution is a payment after you reach age 59½ and at least five years after you make your first contribution. The five-year participation period begins in the year in which you make your first contribution to your Roth account. The ability to withdraw money from your Roth account will depend on your plan rules.

You may roll over your Roth distribution into another Roth account that accepts rollovers or into a Roth IRA account. However, Roth 457(b) distributions cannot be rolled over into a traditional 457(b), 403(b), 401(k) or a traditional IRA, and a Roth IRA may not be rolled over into a Roth 457(b) account. For direct rollovers, the five-year period begins on the first day of the first taxable year in which the employee made Roth deferrals to the other plan, if earlier than the first day of the first taxable year in which the employee made Roth deferrals to the plan receiving the rollover.

Questions? Email: [email protected] | Phone: (405) 848-0258 | Toll Free: 1-866-848-0258

Page 7: Dear Glen Rose ISD Employee, - Glen Rose Independent ... › wp-content › uploads › 2019 › 11 › 457... · a portion of your pay to your Plan account each payday through convenient

Answer the questions below and follow the path indicated to make a preliminary determination as to which type of plan contributions - traditional pretax deferrals or after-tax Roth contributions - might be best for you.

Which Route Is Best For You?

The chart assumes you are contributing the same amount to the plan, whether you choose a traditional pretax deferral or a Roth contribution. With that approach, your spendable pay would be reduced during your working years by the amount of tax paid on the Roth contributions.

This chart is only intended to be a tool that can indicate which type of contribution might be right for you and is not intended to be tax, legal, or accounting advice. Your specific circumstances are not taken into account and may call for a different approach than the one indicated in the chart. Before deciding on a type of contribution, talk with a professional who can take into account any special factors that apply to you.

Consider Roth

Contributions

Consider Pretax

Contributions

Consider Roth

Contributions

Consider Pretax

Contributions

Do you have more

than 10 years of work

before you retire?

Are you currently in

a low tax bracket?

(10% or 15 %)

Do you expect to be in

the same or a higher tax

bracket at retirement?

Can you afford to reduce

your spendable pay now

to avoid taxes later?

Do you expect to be in

the same or a higher tax

bracket at retirement?

Can you afford to reduce

your spendable pay now

to avoid taxes later?

Can you wait at least five

years before you need

your retirement money?

Page 8: Dear Glen Rose ISD Employee, - Glen Rose Independent ... › wp-content › uploads › 2019 › 11 › 457... · a portion of your pay to your Plan account each payday through convenient

Data as of 10/31/2019 Style Symbol*Expense

RatioYTD 1 Year 3 Year 5 Year 10 Year

MONEY MARKET & FIXED INCOME

AUL Fixed Annuity Fixed AnnuityAUL-12G

1.5% 1.7% 1.6% 1.7% N/A

Vanguard GNMA Adm Gov't Bond VFIJX 0.11 5.8% 8.5% 2.3% 2.6% 3.4%

Vanguard Total Bond Market Index Adm Bond Index VBTLX 0.05 8.9% 11.5% 3.3% 3.2% 3.7%

BALANCED

American Funds American Balanced R6 Balanced RLBGX 0.28 14.7% 11.7% 10.0% 7.9% 10.6%

LARGE CAP EQUITY

American Funds American Mutual R6 Large Value RMFGX 0.30 16.0% 11.7% 12.4% 8.9% 12.1%

Delaware Value® R6 Large Value DDZRX 0.58 13.4% 6.9% 9.9% 8.0% 12.9%

American Funds Growth Fund of Amer R6 Large Growth RGAGX 0.31 19.2% 11.9% 15.0% 11.2% 13.4%

Harbor Capital Appreciation Retirement Large Growth HNACX 0.58 22.4% 13.7% 18.2% 12.9% 14.6%

Vanguard 500 Index Admiral Large Cap Blend VFIAX 0.04 23.1% 14.3% 14.9% 10.7% 13.7%

MID CAP EQUITY

Vanguard Mid Cap Index Admiral Mid Blend VIMAX 0.05 24.0% 14.4% 12.2% 8.7% 13.7%

SMALL CAP EQUITY

Vanguard Small Cap Value Index Admiral Small Value VSIAX 0.07 16.5% 5.6% 9.0% 6.9% 12.5%

Vanguard Small Cap Growth Index Admiral Small Growth VSGAX 0.07 23.2% 12.1% 15.0% 9.2% 14.1%

INTERNATIONAL EQUITY

Harbor International Retirement International Value HNINX 0.69 16.1% 10.3% 5.0% 1.9% 4.8%

Artisan International Institutional Institutional Growth APHIX 0.96 23.7% 17.2% 11.7% 4.8% 7.7%

American Funds Europacific Growth R6 International Growth RERGX 0.49 19.7% 15.2% 9.4% 5.7% 6.7%

ASSET ALLOCATION FUNDS

Vanguard Target Retirement Income Inv Balanced VTINX 0.12 11.2% 10.5% 5.8% 4.5% 5.9%

Vanguard Target Retirement 2015 Inv Balanced VTXVX 0.13 12.3% 10.9% 7.0% 5.3% 7.5%

Vanguard Target Retirement 2025 Inv Balanced VTTVX 0.13 15.5% 12.2% 8.9% 6.4% 8.8%

Vanguard Target Retirement 2035 Inv Balanced VTTHX 0.14 17.1% 12.3% 10.2% 7.0% 9.8%

Vanguard Target Retirement 2045 Inv Balanced VTIVX 0.15 18.4% 12.4% 11.0% 7.4% 10.2%

Vanguard Target Retirement 2055 Inv Balanced VFFVX 0.15 18.4% 12.4% 11.0% 7.3% N/A

PLAN PERFORMANCE

Disclosure: The rate of interest credited on the AUL Fixed Annuity is subject to change each quarter of the calendar year. Past performance is no guarantee of future results. Redemption value may be more or less than original cost. Data used to compile this report was obtained from sources deemed reliable. All investments are subject to risk, including loss of principal. Risk is defined as fluctuation in returns from one period to the next and the potential for loss. A well diversified portfolio may help investors reduce the risk associated with investing. However, diversification does not insure protection against a loss in a declining market. This report has been prepared for the purpose of providing a comparison among the advisors and indices shown herein. Indices are for comparison only. The inclusion of an advisor in this report should not be considered an endorsement or recommendation. *The expense ratio is represented by the net prospectus expense ratio. Performance reported prior to the fund's inception date is calculated using the oldest share class. Source: Morningstar Direct

Page 9: Dear Glen Rose ISD Employee, - Glen Rose Independent ... › wp-content › uploads › 2019 › 11 › 457... · a portion of your pay to your Plan account each payday through convenient

Participant Enrollment Form/Investment Election FormFFInvest 457(b) Plan

PARTICIPANT INFORMATION (Please Print Information Clearly)Employer Name:Employee Name:Street:Social Security Number: Primary Email Address:Alternative Email Address:

Date of Birth:City: State: Zip:

Date of Hire: Married: Single:Daytime Phone #:

CONTRIBUTION ELECTIONElective Deferrals

I elect to participate and contribute ______% or $________________ of compensation per pay period on a pre-tax basis

I elect to participate and contribute ______% or $________________ of compensation per pay period to a Roth account (Maximum for all accounts - pre-tax and Roth contributions: $19,000 for 2019)

I elect not to make contributions until further notice.

Catch-up ContributionsIf you will be 50 years old or older as of the last day of the calendar year and otherwise contribute the maximum allowable amount to the Plan, you are entitled to make additional “catch-up” contributions of up to $6,000 for 2019. See the Plan Administrator or Plan Trustee for more details on how to make these catch-up contributions. You may be eligible for a special catch-up option if you did not defer the maximum amount in prior years. If applicable, you could contribute the unused or underutilized deferral amount in any one or all three calendar years ending prior to the calendar year of the plan’s stated normal retirement age.

INVESTMENT ELECTIONI authorize all contributions to be invested as follows:

AUL Fixed Interest Account ____% Vanguard Small-Cap Growth Index Fund (Adm) VSGAX ____%

Vanguard GNMA Fund (Adm) VFIJX ____% Harbor International Fund (Ret) HNINX ____%

Vanguard Total Bond Market Index Fund (Adm) VBTLX ____% Artisan International Fund (I) APHIX ____%

American Funds American Balanced Fund (R6) RLBGX ____% American Funds EuroPacific Growth Fund (R6) RERGX ____%

American Funds American Mutual Fund (R6) RMFGX ____% Vanguard Target Retirement Income Fund (Inv) VTINX ____%

Delaware Value Fund (R6) DDZRX ____% Vanguard Target Retirement 2015 Fund (Inv) VTXVX ____%

American Funds Growth Fund of America (R6) RGAGX ____% Vanguard Target Retirement 2025 Fund (Inv) VTTVX ____%

Harbor Capital Appreciation Fund (Ret) HNACX ____% Vanguard Target Retirement 2035 Fund (Inv) VTTHX ____%

Vanguard 500 Index Fund (Adm) VFIAX ____% Vanguard Target Retirement 2045 Fund (Inv) VTIVX ____%

Vanguard Mid-Cap Index Fund (Adm) VIMAX ____% Vanguard Target Retirement 2055 Fund (Inv) VFFVX ____%

Vanguard Small-Cap Value Index Fund (Adm) VSIAX ____% Must indicate whole percentages and total 100% 100%

If you do not make a selection, contributions will be allocated to the Plan’s default fund(s) until your investment elections are received. See the “How Are Plan Contributions Invested?” section of the Plan Highlights for more information.

SIGNATURES

Participant’s Signature: Date:

For more information about your Plan, you can access the Internet Site at www.my457account.com. Like other Retirement Plans, the FFInvest 457(b) Plan is intended to be a long-term Retirement Investment Vehicle; accordingly, withdrawals of an individual’s deferred compensation contributions and earnings are generally only permit-ted under certain conditions i.e., death, separation from service (includes termination of employment or retirement at any age), an unforeseeable emergency as defined by the Internal Revenue Service (IRS) or attainment of age 70 1/2. *If no effective date is indicated, change will be effective the next available payroll available for changes. For more information, please visit http://ffinvest.my457account.com or call InvesTrust at 1-866-848-0258. Please fax this form to 1-855-300-7454 or deliver to your Payroll/Benefits office.

New Enrollment: Revised Enrollment:

EFFECTIVE*: (form must be signed month prior to effective date)

Page 10: Dear Glen Rose ISD Employee, - Glen Rose Independent ... › wp-content › uploads › 2019 › 11 › 457... · a portion of your pay to your Plan account each payday through convenient

FFInvest 457(b) Plan DesignationBeneficiary Form

Employer Name:______________________________________________________________________________________________

Employee Name:______________________________________________________________________________________________Street: ____________________________________________________

Social Security Number: __________________________________ Date of Birth: _________________________________________

City: ________________ State: ________ Zip: __________

I am not married. I understand that if I become married in the future, this form automatically ceases to apply and I should file a new Designated Beneficiary.

I am married. If my spouse is not the only Primary Beneficiary, my spouse has signed the consent on the bottom of this form. (If consent of your spouse cannot be obtained - e.g., cannot be located or is incapacitated - contact your employer for information about possible alternatives.) I understand that if my marital status changes, this Designation will nevertheless remain in effect until I file a new Designation.

I hereby revoke any Designation of Beneficiary I may previously have made under the above Plan and designate the following as my Beneficiary under the Plan:

BENEFICIARY DESIGNATION

Name:____________________________ Relationship:__________________ SSN:___________ DOB:____________ %Share:______

Name:____________________________ Relationship:__________________ SSN:___________ DOB:____________ %Share:______

Name:____________________________ Relationship:__________________ SSN:___________ DOB:____________ %Share:______

Contingent Beneficiary:

Name:____________________________ Relationship:__________________ SSN:___________ DOB:____________ %Share:______

Name:____________________________ Relationship:__________________ SSN:___________ DOB:____________ %Share:______

Name:____________________________ Relationship:__________________ SSN:___________ DOB:____________ %Share:______

Primary Beneficiary:

CURRENT MARITAL STATUS: (check one)

Signature of Participant:___________________________________________________________Date:_________________________

SPOUSE’S CONSENT

I hereby approve of, and consent to, the beneficiary designation adopted by my spouse as provided above. I understand that I am enti-tled to receive spouse’s benefit under the Plan unless I consent to a different beneficiary designation. I also understand that the above designation has the effect of causing the death benefit under the Plan to be paid to another beneficiary. I further understand that my spouse may not change the primary beneficiary designation on this page hereof without first obtaining my written consent.

Name of Spouse:______________________________Spouse’s Signature:_________________________________Date:____________

Sworn to, and witnessed by me, this_____day of____________________(month),__________________________________________

Name of Notary Public:_________________________________________________________________________________________

Notary Public’s Signature:__________________________________If not notarized, witnessed by:_____________________________

Name of Plan Administrator:_______________________Plan Administrator’s Signature:____________________Date:____________