State Farm Change Of Beneficiary Form PDF Details

The State Farm Change of Beneficiary form is a crucial document for individuals who hold accounts with State Farm Mutual Funds, including Traditional IRA, Roth IRA, SEP IRA, SIMPLE IRA, Tax Sheltered Accounts (TSA) under 403(b)(7), and Archer Medical Savings Accounts (MSA). It allows account holders to designate or modify the beneficiary(ies) of their accounts, ensuring that their assets are transferred to their chosen individuals upon their death. This form also provides the means to revoke any previous beneficiary designations, making the latest submission the valid instruction for account succession. The process requires complete beneficiary information, the account holder's signature, and in certain cases, the signature of the spouse or partner, especially if they are not named as the sole primary beneficiary and reside in specific community property states. Additional provisions outlined in the State Farm Mutual Funds Custodial Account Agreements highlight the importance of compliance with the form's requirements, such as filing the completed form with the Custodian before the account holder's death and adhering to instructions for naming more than four primary or secondary beneficiaries. Given the legal and emotional implications of beneficiary designations, the document underscores the necessity of careful consideration and possibly seeking advice before making such significant decisions.

QuestionAnswer
Form NameState Farm Change Of Beneficiary Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesfarm beneficiary form, state farm change of benficiary form, state farm change beneficiary, statefarm designation change

Form Preview Example

Designation or Change of Beneficiary Request

State Farm Mutual Funds® Individual Retirement Accounts, Tax Sheltered Accounts (TSA)

under 403(b)(7), or Archer Medical Savings Accounts (MSA).

This form is used to designate or change the Beneficiary(ies) of your Traditional IRA, Roth IRA, SEP IRA, SIMPLE IRA, TSA, or MSA. If you wish to establish a transfer on death beneficiary on your non-tax qualified State Farm Mutual Fund account, please call and request a Designation or Change of Transfer on Death (TOD) Beneficiary Form.

By completing this form you revoke any prior death beneficiary designation and name the following as the beneficiary(ies) of this account, subject to your right to change this designation as provided in the applicable Custodial Account Agreement.

If you have any questions or need additional information before completing this form, please call 1-800-447-4930.

1 Instructions

1.This form is deemed valid by the Custodian if the following requirements have been met:

a)The beneficiary information is complete.

b)It is signed and dated by the Participant.

c)Your spouse/partner has signed the form - if required.

d)It is filed with the Custodian prior to your death.

2.To name more than four primary or secondary beneficiaries:

a)Attach a separate page and include, for each beneficiary, all of the information requested on this form. Have your spouse/partner sign the page, if required.

b)Sign and date the additional page.

c)Have your spouse/partner sign the page, if required.

3.See the applicable State Farm Mutual Funds Custodial Account Agreements for additional provisions.

2 Participant Information

First Name

MI

Last Name

Address

Social Security Number

City

Account Number

 

State

 

ZIP Code

 

 

 

 

 

Telephone Number

Marital Status

 

 

 

Single

Married

 

 

 

 

 

3 Designation of Beneficiary

(PRIMARY BENEFICIARY(IES)

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total = 100%

1004549

104203.5 05-14-2014

(SECONDARY BENEFICIARY(IES)

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total = 100%

4 Signature(s)

Participant's Signature

Date

Signature of Spouse/Partner (if required*)

*Note: Spouse or partner's signature is required if the spouse/partner is not the sole primary beneficiary for this account and the spouse/partner and/or Participant resides in Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington or Wisconsin. By signing, the spouse/partner voluntarily and irrevocably consents to the beneficiary designation set forth above and waives all rights he/she may have with respect to the account, except for any rights provided under the applicable Custodial Account Agreement.

Please fax or mail all signed completed forms to: State Farm Mutual Funds

P.O. Box 219548

Kansas City, Missouri 64121-9548

FAX: 1-816-471-4832

1004549

104203.5 05-14-2014

How to Edit State Farm Change Of Beneficiary Form Online for Free

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Step 1: Hit the "Get Form Now" button to get going.

Step 2: The document editing page is presently open. You can add text or enhance present data.

The PDF template you decide to fill in will consist of the following areas:

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Note the data in Name, Street, S E, Y R A C F E N E B Y R A D N O C E S, Name, Street, Name, Street, Name, Street, Signatures, SSNTIN, Relationship, Date of Birth MonthDayYear, and of Account.

part 2 to completing farm change beneficiary

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