ࡱ> ;=:#` 4"bjbj\.\. 4&>D>D (  (` $LhE  777   7 777 Pa@ :700`76Z6767\ " 7  - ` ((( ((( ((( STATE OF DELAWARE DESIGNATION OF BENEFICIARY Name of Pensioner ___________________________ Last, First, Middle (PLEASE PRINT) Social Security No. or Employee ID:______ ____ _______ _ _____ _ In accordance with section 5546, Title 29, Delaware Code, I hereby direct that any amount of group benefit payable at my death be paid to the Beneficiary designated below if living. If more than one Beneficiary is designated, payment will be made in equal shares to such of the designated Beneficiaries (or Beneficiary) as survive the Retiree, unless otherwise specified herein. If at the death of the Retiree, there is no designated Beneficiary, for all or any part of the death benefit, the amount of death benefit payable for which there is no designated Beneficiary shall be payable to the estate of the Retiree. However, the Pension Fund at its option, may pay such amount to any one of the surviving relatives: wife, husband, mother, father, child or children and payment to any one or more of such surviving relatives shall completely discharge the Pension Funds liability with respect to the amount of death benefit paid. Do not erase or attempt to make any corrections on this form. Use a new form if you make a mistake. Primary/Secondary m m 1.___________________________________________________________________ Name of Beneficiary (PLEASE PRINT) Date of Birth Relationship ___________________________________________________________________ Address of Beneficiary Social Security # m m 2.___________________________________________________________________ Name of Beneficiary (PLEASE PRINT) Date of Birth Relationship ___________________________________________________________________ Address of Beneficiary Social Security # m m 3.______________,-.?Kq      # % & ' ( - . / 1 < D E N ĿĿӵؒ؍{tmt h"T5CJ hxw5CJh{1)h9"5CJaJ hcCJ hQ>* hi'>* hw`>* h6>* h Y>* h%>* hxw>* hE>* hG>* hU*X>* h\n5 hxw5 hw@5 hET>* h#[>* he\>* hc5 hcCJhc hcCJ hc7CJ hc5CJ'-.0 1 = O Xl>Rgd.cC`^`gd.cC `^``gdxw 0^0`gdE `^``gd.cCgdxw`^`gdxwgd#^gdxw$a$4"N O Xj~>Pd 6 X!Y!a!Ÿ}U h.cC5h.cCh.cC5h.cC hs5hidh.cC5CJ0aJ hsh.cC5 hc5 hgH_5 hxw5h.cChc5 hE5h.cChgH_5hchgH_hxwhshc5hidhxw5CJ0aJ hshxw5hxwhxw5CJ/6 W!X!Y!!!!!!" "%"4"`gds $7$8$H$a$$7$8$H$^`a$gdsgd.cC`^`gd.cC `^``gd.cC_____________________________________________________ Name of Beneficiary (PLEASE PRINT) Date of Birth Relationship ___________________________________________________________________ Address of Beneficiary Social Security # Signature:____________________________________Date:______________ Sworn to and subscribed before me this _____ day of ______________20__ _____________________________ Notary Public GL-1 Revised Nov 06 a!i!!!"#"$"-"3"4"hxwhc7hc hs5 hc5 h"T5 21h:p~/ =!"#$`% @@@ NormalCJ_HaJmH sH tH :@: Heading 1$@&5\H@H Heading 2$$@&a$5CJ\aJDA@D Default Paragraph FontViV  Table Normal :V 44 la (k(No List 0>@0 Title$a$CJ<J@< Subtitle$a$ 5CJ\HH S\ Balloon TextCJOJQJ^JaJ.X@!. -&Emphasis6] &-.01=OTpz5: $ D E c q v 0000000000000000@000@00@000@0@00000000000N a!4" 4" 4" 8@0(  B S  ?z x d{ x D'  9*urn:schemas-microsoft-com:office:smarttagsplace9*urn:schemas-microsoft-com:office:smarttagsState M$ !?q#&'(-./1   !%&(),-1234;=DENQRST[S]dey57899 C J K   ) * - . b c i j u v } ~  * - 3333?#&'(-.//00<DEQQRRy55 $ $ E E c c t u  QPoXYw E,CeJ TWX {I < y I m P] aa - V%2e~J#3Y6=m@vG]8tUw2aX C;=cT v[ !N!$"9"s"@P$ S$ %&-&p&eY'i'8(w*6N+T,B..~ 0)33M4\55)6c7]Q8@m8L}9%: ;S:; ={J=$>T? {?@)@W@w@P A)A=BNC.cCE\.FGd*GHI7I@JKLELlMu;NR_9S=SVSET"T|hU3rUrU5U[AVHWBxWXXU*XY#[S\^F%_&_gH_R_l6`w`&aUbfdid.f g%hChphjSj~jWmn psApqjp{ps q,q yr=uduv.v5v1w6wDUwF x,xz,zXzh{`J~5K~{w~j<>QG :wEzzKJ]js.EJ3BN|j,M&L4gc61Q`L*sSL  /yC0.?PH)IiPT;Ry+Rx I n@,z=D g1i3 Ygh5+M#e\ht#.,wr 5'LHf4E(fxLwQC**/420aj\n~+%^R?Jg3swJtxU E|>/{?C\]e $*qq xw(?}NQ:4G&HGsZc< @{$@QQQQ @@@UnknownGz Times New Roman5Symbol3& z Arial5& z!Tahoma"1h˱˱@"!24d 2QHX(?H2STATE OF DELAWARE James G. ConkPension OfficeOh+'0  8D d p | STATE OF DELAWAREJames G. Conk DesignationOfBeneficiary.dotPension Office2Microsoft Office Word@F#@0@l[@@l[@՜.+,0 hp   Conk's Communication Service  STATE OF DELAWARE Title  !"#$%&'()+,-./013456789<Root Entry F@a@>Data 1Table6WordDocument4&SummaryInformation(*DocumentSummaryInformation82CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q