*+15* TEACHER RETIREMENT SYSTEM OF TEXAS 1000 Red River Street, Austin, Texas 78701-2698 Telephone (512) 542-6400 or 1-800-223-8778 www.trs.state.tx.us TRS 15 Rev. 01-12 DESIGNATION OF BENEFICIARY Name Social Security No. (As it appears on TRS records) Complete this form TRS 15 to designate a beneficiary or beneficiaries for active member death benefits or retiree survivor benefits. Please read the Instructions and Information for Designating a Beneficiary on the reverse side for important information about completing this form and how TRS will use this form. PRIMARY BENEFICIARY OR JOINT PRIMARY BENEFICIARIES I designate the following person(s) as my primary beneficiary(ies) to receive the benefits described above that may be due from TRS upon my death (surviving designated joint primary beneficiaries will receive equal portions, share and share alike): Name Social Security No. Relationship Date of Birth Address ALTERNATE BENEFICIARY OR JOINT ALTERNATE BENEFICIARIES In the event the primary beneficiary(ies) predeceases me, waives the benefits, or is ineligible to receive the benefits, I designate the following person(s) as my alternate beneficiary(ies), to receive the benefits described above that may be due from TRS upon my death (surviving designated joint alternate beneficiaries will receive equal portions, share and share alike): Name Social Security No. Relationship Date of Birth Address A blank designation of beneficiary on a TRS form that is signed by you revokes any previous designation for the applicable benefits and leaves no designation of beneficiary. When no beneficiary is designated, applicable law determines who will receive benefits after your death. Signature of Member or Retiree STATE OF On (date) a notary public. Signature of Notary Public Date COUNTY OF , (printed name of person whose signature appears above) acknowledged this document before me (SEAL) This form TRS 15 cannot be used to designate a beneficiary(ies) for monthly retirement benefits under an optional retirement payment plan (Option 1, 2, 3, 4, or 5). If you wish to change your beneficiary under an optional retirement payment plan, request a Change of Beneficiary for Continuing Optional Retirement Annuity form from TRS.
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