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DRS Beneficiary Designation Form
Handle: Document-14480
Owner: Hanson, Jean (User-867, 07736:EVERETT)DS
Monday, January 28, 2008 02:47:28 PM PST
Tuesday, January 5, 2016 07:56:40 AM PST
Modified By:
Locked By:
  • Return completed form to:
Post Office Box 48380Olympia, WA 98504-8380Toll Free: 1-800-547-6657Local: 360-664-7000TDD: 360-586-5450Washington StateDepartment of Retirement Systems (DRS)Beneficiary DesignationCheck one:Instructions: Please type or print in dark ink and return completed form to DRS.
  • For example: MARY K.
  • DOE (not Mrs.
  • Section One: Member/Retiree/Survivor Information
Last name First name Middle name Social Security numberMailing address City State ZipTelephone nu...
Allowed
Adobe Portable Document Format (.pdf) - application/pdf
beneficiaryDesignationForm[1].pdf
4
357252
No
Appears In: Benefits
Preferred Version: DRS Beneficiary Designation Form