Persi Form Rs115 PDF Details

Have you ever wanted to know how to make the most out of a project or task? Everybody wants their efforts to be successful and appreciated, but it’s not always easy. It takes hard work, dedication, and organization. One way of achieving all this is by using Persi Form Rs115. This innovative platform allows users to get organized on tasks with ease while enhancing collaboration within teams in order to improve productivity, accuracy and quality over time. Keep reading if you want a more detailed look into what makes Persi Form Rs115 such an amazing tool that can take your projects from good-to-great!

QuestionAnswer
Form NamePersi Form Rs115
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesRS115 persi beneficiary designation form

Form Preview Example

Be n e f icia r y D e sign a t ion

Pu r p ose of t h e For m

•Use t his for m t o designat e beneficiar ies t o r eceive your PERSI Base Plan and Choice 401( k) Plan deat h benefit s.

I n st r u ct ion s

•Read “ About For m RS115,” at t ached.

M e m be r I n f or m a t ion

N a m e – Fir st , M id d le , La st

 

 

 

 

 

 

 

 

 

Socia l Se cu r it y N u m b e r

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

St r e e t or P . O . Box

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M a ilin g

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Addr e ss

Cit y

 

 

 

 

 

 

St a t e

 

 

Zip Cod e

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D a y t im e Ph on e N u m b e r ( in clu d e a r e a cod e )

 

Em a il Ad d r e ss

 

 

 

 

 

 

M a r it a l St a t u s

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Single

Mar r ied

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pr im a r y Be n e f icia r y or Be n e f icia r ie s

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N a m e

Socia l Se cu r it y or Ta x

 

D a t e of

Re la t ion sh ip t o

 

Be n e fit

 

N om in a t e a cu st od ia n u n d e r

 

I D N u m b e r

 

Bir t h

You

 

%

 

 

 

 

t h e I d a h o UTM A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check t his box and go

 

 

 

 

 

 

 

 

 

 

.0%

 

t o page 2 .

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check t his box and go

 

 

 

 

 

 

 

 

 

 

.0%

 

t o page 2 .

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.0%

 

t o page 2 .

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.0%

 

t o page 2 .

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Se con da r y Be n e f icia r y or Be n e f icia r ie s

 

 

 

 

 

 

 

 

 

N a m e

Socia l Se cu r it y or Ta x

 

D a t e of

Re la t ion sh ip t o

 

Be n e fit

 

N om in a t e a cu st od ia n u n d e r

 

I D N u m b e r

 

Bir t h

You

 

%

 

 

 

 

t h e I d a h o UTM A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check t his box and go

 

 

 

 

 

 

 

 

 

 

.0%

 

t o page 2 .

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check t his box and go

 

 

 

 

 

 

 

 

 

 

.0%

 

t o page 2 .

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check t his box and go

 

 

 

 

 

 

 

 

 

 

.0%

 

t o page 2 .

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check t his box and go

 

 

 

 

 

 

 

 

 

 

.0%

 

t o page 2 .

 

 

M e m be r Ack n ow le dgm e n t

I under st and t he inst r uct ions and infor m at ion under “ About For m RS115 . ” I r ev oke all pr evious PERSI beneficiar y designat ions and r equest t hat any PERSI benefit s payable aft er m y deat h be m ade as indicat ed her ein. I m ay change t his designat ion by filing a new for m . This designat ion applies t o m y PERSI Base and Choice 401( k) Plan account s.

Sig n a t u r e

D a t e

 

 

RS115 ( 02/ 2012) Page 1 of 4

Public Em ploy ee Ret ir em ent Syst em of I daho

 

P. O. Box 83720, Boise, I D

83720 - 0078

 

1 - 800 - 451 - 8228 • 208 - 334 - 3365

• Fax 208 - 334 - 3805

 

ww w . per si. idaho.gov • front desk @persi. idaho. gov

Be n e f icia r y D e sign a t ion - con t in u e d

N a m e – Fir st , M id d le , La st

Socia l Se cu r it y N u m b e r

Cu st odia n N om ina t ions for M in or Be n e ficia rie s un de r t h e I da ho Un iform Tr a nsfe r s t o M in ors Act

•Use t his sect ion t o nom inat e cust odians and subst it ut e cust odians for m inor beneficiar ies under t he I daho Uniform Tr ansfer s t o Minor s Act . At t ach a copy of t his page if nom inat ing cust odians for m or e t han 4 m inor beneficiar ies.

I nst ru ct ion s

•

•

Wr it e t he m inor beneficiary ’s nam e in t he t op box .

Wr it e t he cust odian’s nam e, Social Secur it y num ber , address, and t elephone num ber in t he appropr iat e box es. You can nom inat e a subst it ut e cust odian t o serv e in t he ev ent t he nom inat ed cust odian is unable. List each m inor beneficiary separ at ely , ev en if y ou are nom inat ing t he sam e cust odian for all m inor beneficiar ies.

M in or Be n e ficia ry N a m e :

 

 

 

 

 

 

 

 

Cu st odia n I n for m a t ion

 

 

Subst it ut e I n for m a t ion

 

 

 

 

 

 

 

N a m e :

 

 

N a m e :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSN :

 

 

SSN :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Addr e ss:

 

 

Addr e ss:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cit y , St , Zip:

 

 

Cit y , St , Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Te le ph on e :

 

 

Te le ph on e :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M in or Be n e ficia ry N a m e :

 

 

 

 

 

Cu st odia n I n for m a t ion

 

 

Subst it ut e I n for m a t ion

 

N a m e :

 

 

N a m e :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSN :

 

 

SSN :

 

 

 

 

 

 

 

 

 

 

 

 

 

Addr e ss:

 

 

Addr e ss:

 

 

 

 

 

 

 

 

 

 

 

 

 

Cit y , St , Zip:

 

 

Cit y , St , Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

Te le ph on e :

 

 

Te le ph on e :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M in or Be n e ficia ry N a m e :

 

 

 

 

 

Cu st odia n I n for m a t ion

 

 

Subst it ut e I n for m a t ion

 

N a m e :

 

 

N a m e :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSN :

 

 

SSN :

 

 

 

 

 

 

 

 

 

 

 

 

 

Addr e ss:

 

 

Addr e ss:

 

 

 

 

 

 

 

 

 

 

 

 

 

Cit y , St , Zip:

 

 

Cit y , St , Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

Te le ph on e :

 

 

Te le ph on e :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M in or Be n e ficia ry N a m e :

 

 

 

 

 

Cu st odia n I n for m a t ion

 

 

Subst it ut e I n for m a t ion

 

N a m e :

 

 

N a m e :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSN :

 

 

SSN :

 

 

 

 

 

 

 

 

 

 

 

 

 

Addr e ss:

 

 

Addr e ss:

 

 

 

 

 

 

 

 

 

 

 

 

 

Cit y , St , Zip:

 

 

Cit y , St , Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

Te le ph on e :

 

 

Te le ph on e :

 

 

 

 

 

 

 

 

 

RS115 ( 02/ 2012) Page 2 of 4

Public Em ploy ee Ret ir em ent Syst em of I daho

 

P. O. Box 83720, Boise, I D

83720 - 0078

 

1 - 800 - 451 - 8228 • 208 - 334 - 3365

• Fax 208 - 334 - 3805

 

ww w . per si. idaho.gov • front desk @persi. idaho. gov

 

Ab o u t For m RS1 1 5

 

 

 

I n st r u ct io n s

1

Com plet e t he for m and sign in blue or black ink .

2

U se w h ole pe r ce n t a ge s on ly .

3

I f m or e space is needed, at t ach an addit ional signed and dat ed sheet of paper .

4

I f any designat ed beneficiar y is a m inor , com plet e page 2 if you choose t o nom inat e an adult cust odian t o

 

r eceive t he funds for t he m inor . PERSI cannot pay a deat h benefit dir ect ly t o a m inor beneficiar y .

5Send t he for m t o PERSI .

N ot e : The for m is not valid unless signed, dat ed, and on file w it h PERSI .

Ty pe s of Be n e f icia r ie s

•Pr im a r y be n e f icia r y or be n e f icia r ie s. The fir st per son or per sons t o r eceive deat h benefit s w hen you die. I f you select one per son only, he or she r eceives 100% of t he benefit s.

•

Se con da r y be n e f icia r y or be n e f icia r ie s. Per son or per sons t o r eceive deat h benefit s if no pr im ar y beneficiar y

 

or beneficiar ies ar e alive w hen you die.

•

D e f a u lt be n e f icia r y . I f PERSI does not have a beneficiar y designat ion on file, deat h benefit s ar e paid by law t o

 

t he follow ing: ( 1) To your sur viving spouse. ( 2) I f you have no sur viving spouse, t o your est at e. I f you agr ee

 

w it h t his default dist r ibut ion and you have not pr eviously subm it t ed a beneficiary designat ion for m , you do not

 

need t o designat e a beneficiar y or subm it t his for m . How ever , paym ent of deat h benefit s could be delayed if

 

PERSI has no designat ion on file.

 

 

 

N ot e s Abou t D e sig n a t in g Be n e f icia r ie s

•

Per cent ages m ust be in w hole num ber s. Do n ot use par t ial num ber s. For exam ple, use 33% not 33 ⅓% .

•

Choose your beneficiar ies car efully . Your PERSI funds m ight be your lar gest financial asset .

•

I f you select t w o or m or e people as pr im ar y or secondar y beneficiar ies, indicat e w hat per cent age each is t o

 

r eceive ( t he per cent ages m ust equal 100% ) .

•You m ust list your childr en separ at ely .

• I f you ar e designat ing one or m or e m inor s as beneficiar y, you should specify how you w ant your deat h benefit

t r ansfer r ed if you die befor e t he beneficiar y r eaches legal age of m aj orit y . PERSI cannot disper se t he m oney t o a m inor , so if you don’t nom inat e a cust odian on t his for m , a cour t m ay have t o appoint an adult t o ser ve as conser vat or of t he funds. This for m pr ovides an easy and inexpensive w ay t o t r ansfer deat h benefit s t o a m inor

t hr ough t he I daho Unifor m Tr ansfer s t o Minor s Act ( UTMA) . This law enables you t o nom inat e a cust odian, and subst it ut e cust odian, for y our m inor beneficiar y, and aut hor izes PERSI t o pay y our deat h benefit t o t he cust odian. To nom inat e a cust odian for a m inor beneficiar y, fill out page 2 of t his for m .

•I f you use t he UTMA t o nom inat e a cust odian for your m inor beneficiar y, be aw ar e t hat t he legal age of m aj or it y under t he UTMA is 21, even t hough t he st at ut or y age of m aj or it y in I daho is 18 . I f you die befor e your

beneficiar y is 21 year s of age, t he m oney w ill go t o and r em ain in t he cust odian’s car e unt il t he beneficiary r eaches age 21 .

• Alw ays pr ovide full nam es ( Mar y Elizabet h Sm it h, n ot Mar y Sm it h) . For a m ar r ied w om an, use her full nam e ( Mar y Elizabet h Sm it h, n ot Mr s. Bob Sm it h) . I nclude t he r elat ionship t o you.

•This beneficiar y designat ion is for PERSI Base Plan and Choice 401( k) Plan deat h benefit s on ly . Any designat ions

you m ake for a w ill or an insur ance policy do not subst it ut e for t he PERSI beneficiar y designat ion.

• Subm it a new Beneficiar y Designat ion ( RS115) t o PERSI if your m ar it al st at us changes.

•Com plet e a Mem ber Nam e Change ( RS111) if your nam e changes. I f you ar e an act ive m em ber , ( w or king for a

PERSI em ployer and m aking cont r ibut ions) give t he for m t o your payr oll cler k . I f not , send t he for m t o PERSI .

• You can change your designat ions at any t im e by subm it t ing a new Beneficiar y Designat ion ( RS115) t o PERSI .

•I f you m ake an er r or , init ial and dat e any cor r ect ions.

M in or Ch ildr e n , Tr u st s, W ills, a n d Ch a r it ie s a s Be n e f icia r ie s

• M in or ch ildr e n . To designat e a m inor child as a pr im ar y or secondar y beneficiar y, you should consider

t r ansfer r ing t he m oney t o a cust odian for t he child under t he pr ovisions of t he I daho Unifor m Tr ansfer s t o Minor s

RS115 ( 02/ 2012) Page 3 of 4

Public Em ploy ee Ret ir em ent Syst em of I daho

 

P. O. Box 83720, Boise, I D

83720 - 0078

 

1 - 800 - 451 - 8228 • 208 - 334 - 3365

• Fax 208 - 334 - 3805

 

ww w . per si. idaho.gov • front desk @persi. idaho. gov

Act ( UTMA) . Using PERSI for m RS115 page 2 m eet s t he UTMA r equir em ent s.

• Tr u st s. I f you w ant t o designat e your Living Tr ust , show t he dat e of t he t r ust agr eem ent and t he nam e( s) of t he Tr ust ee( s) . I f a bank or t r ust com pany is t he Tr ust ee, at t ach a separ at e docum ent cont aining t he Tr ust ee’s addr ess. Pr ovide PERSI w it h a copy of t he t r ust ’s r egist r at ion, if available. The t r ust m ust have a t ax I D num ber .

•W ills. Wr it e “ t he Execut or of m y Est at e” or “ t he Adm inist r at or of m y Est at e” t o designat e your est at e as

beneficiar y . Do not nam e t he execut or , because t he execut or w ill be appoint ed lat er by t he cour t .

• Ch a r it ie s. You can nam e a specific char it y as beneficiar y . For m or e infor m at ion about paym ent of deat h benefit s t o char it ies, PERSI r ecom m ends t hat you consult w it h a qualified at t or ney .

Ex a m p le 1

Pr im a r y Be n e f icia r y or Be n e f icia r ie s

N a m e

Socia l Se cu r it y or

D a t e of Birt h

Re la t ion sh ip

Be n e fit

N om in a t e a cu st odia n

Ta x I D N um be r

t o You

%

u n de r t h e I da h o UTM A

 

 

 

 

 

 

 

 

Phillip Lee Thom pson

000 - 01 - 0011

07 - 11 - 1937

Spouse

100 .0%

Check t his box and go

 

 

 

 

 

t o page 2 .

 

 

 

 

 

Check t his box and go

 

 

 

 

 

t o page 2 .

Se con da r y Be n e f icia r y or Be n e f icia r ie s

N a m e

Socia l Se cu r it y or

D a t e of Birt h

Re la t ion sh ip

Be n e fit

N om in a t e a cu st odia n

Ta x I D N um be r

t o You

%

u n de r t h e I da h o UTM A

 

 

 

 

 

 

 

 

John Allen Sm it h

000 - 08 - 0025

01 - 09 - 1997

Son

80.0%

Check t his box and go

 

 

 

 

 

t o page 2 .

Rebecca Joan Sm it h

000 - 02 - 0220

01 - 02 - 1958

Sist er

20.0%

Check t his box and go

 

 

 

 

 

t o page 2 .

 

 

Ex a m ple 2

 

 

 

 

 

 

 

 

Pr im a r y Be n e f icia r y or Be n e f icia r ie s

 

 

N a m e

Socia l Se cu r it y or

D a t e of Birt h

Re la t ion sh ip

Be n e fit

N om in a t e a cu st odia n

Ta x I D N um be r

t o You

%

u n de r t h e I da h o UTM A

 

 

 

 

 

 

 

 

Sally Jones

000 - 03 - 0033

08 - 21 - 1994

Daught er

34.0%

Check t his box and go

 

 

 

 

 

t o page 2 .

Alice Jones

000 - 04 - 0044

11 - 14 - 1991

Daught er

33.0%

Check t his box and go

 

 

 

 

 

t o page 2 .

Andrew Jones

000 - 05 - 0055

02 - 29 - 1987

Son

33.0%

Check t his box and go

 

 

 

 

 

t o page 2 .

 

 

 

 

 

Se con da r y Be n e f icia r y or Be n e f icia r ie s

 

 

N a m e

Socia l Se cu r it y or

D a t e of Birt h

Re la t ion sh ip

Be n e fit

N om in a t e a cu st odia n

Ta x I D N um be r

t o You

%

u n de r t h e I da h o UTM A

 

 

 

 

 

 

 

 

The adm inist r at or of m y est at e

 

 

Est at e

100 .0%

Check t his box and go

 

 

 

 

 

t o page 2 .

 

 

 

 

 

Check t his box and go

 

 

 

 

 

t o page 2 .

RS115 ( 02/ 2012) Page 4 of 4

Public Em ploy ee Ret ir em ent Syst em of I daho

 

P. O. Box 83720, Boise, I D

83720 - 0078

 

1 - 800 - 451 - 8228 • 208 - 334 - 3365

• Fax 208 - 334 - 3805

 

ww w . per si. idaho.gov • front desk @persi. idaho. gov

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Persi Form Rs115 writing process outlined (step 1)

2. After filling out the last part, head on to the subsequent part and fill in all required details in all these fields - N a m e, I D N u m be r, Bir t h, You, t he I da ho UTM A, Check t his box and go t o page, M e m be r Ack now le dgm e nt, I underst and t he inst ruct ions, Signa t ur e, D a t e, RS Page of, and Public Em ploy ee Ret ir em ent.

M e m be r Ack now le dgm e nt, Check t his box and go t o page, and I D N u m be r of Persi Form Rs115

3. This step is generally hassle-free - fill out every one of the fields in N a m e Fir st M iddle La st, Socia l Se cur it y N u m be r, Be n e ficia r y D e signa t ion, Cu st odia n N om ina t ions for M, Use t his sect ion t o nom inat e, Minor s Act At t ach a copy of t, I nst ru ct ion s Wr it e t he m, nom inat e a subst it ut e cust, M in or Be n e ficia ry N a m e, Cu st odia n I n for m a t ion, Subst it ut e I n for m a t ion, N a m e, SSN, Addr e ss, and Cit y St Zip to conclude the current step.

How to fill out Persi Form Rs115 stage 3

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The way to fill out Persi Form Rs115 stage 4

5. This last notch to submit this form is pivotal. Be sure you fill in the necessary blank fields, particularly Addr e ss, Cit y St Zip, Te le ph on e, Addr e ss, Cit y St Zip, Te le ph on e, RS Page of, and Public Em ploy ee Ret ir em ent, prior to using the form. Failing to do it might produce an unfinished and potentially unacceptable document!

Addr e ss, Cit y St Zip, and Addr e ss inside Persi Form Rs115

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