Age-Based In-Service Withdrawal Request - Thrift Savings Plan Page 2
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1
2
3
4Name:
TSP Account Number:
(Last, First, Middle)
VII. MARRIED FERS AND UNIFORMED SERVICES PARTICIPANTS —
Your spouse must consent to your withdrawal. Your
spouse’s signature must be notarized.
17. Spouse: By signing below, I consent to this withdrawal from my spouse’s Thrift Savings Plan ac count. I understand that
the amount withdrawn will not be available later for the purchase of a joint and survivor annuity.
Spouse’s Name (Last, First, Middle)
/
/
18.
19.
Date Signed (mm/dd/yyyy)
Spouse’s Signature
20.
Notary: Please complete the following. No other acknowledgement is acceptable (see instructions).
The person who signed Item 18 is known to or was identified by me and, before me, signed or acknowledged to have
signed this form. In witness thereof, I have signed below on this
day of
,
.
Month
Year
My commission expires:
Date (mm/dd/yyyy)
Notary’s Signature
(
)
Notary’s Printed Name
Notary’s Phone Number
[seal]
Jurisdiction
21. Participant: If you cannot obtain your spouse’s signature, provide your
spouse’s name (Item 17) and Social Security number on the right, and
Spouse’s Social Security Number
submit Form TSP16, Exception to Spousal Requirements (TSPU16 for
uniformed services), with the required documentation.
VIII. MARRIED CSRS PARTICIPANTS —
Your spouse must be notified of your withdrawal request.
22.
Spouse’s Name (Last, First, Middle)
23.
Is your spouse’s address the same as your address in your TSP record?
Don’t know spouse’s address.
Yes
No (Complete Items 24 – 28.)
(Provide spouse’s SSN and submit
Form TSP16.)
Spouse’s Social Security Number
Spouse has
24.
25.
foreign address?
Street Address or Box Number (For a foreign address, see instructions.)
Check here.
Street Address Line 2
–
26.
27.
28.
Zip Code
State
City
Do Not Write Below This Line
Form TSP-75, Page 2 (2/2015)
PREVIOUS EDITIONS OBSOLETE
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