Tsp-77 - Request For Partial Withdrawal When Separated
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4THRIFT SAVINGS PLAN
TSP-77
REQUEST FOR PARTIAL WITHDRAWAL
WHEn SEPARATED
Participants who are separated from Federal service can use this form to request a one-time partial withdrawal of $1,000 or more from
their TSP accounts. You cannot make another partial withdrawal from this TSP account if you have previously made one, or if you have previ-
ously made an age-based in-service withdrawal. Read the information and instructions for completing this form. They will help you under-
stand the rules for making a partial withdrawal.
I.
1.
Name
INFORMATION
Last
First
Middle
ABOUT YOU
2.
3.
4.
/
/
(
)
–
TSP Account Number
Date of Birth (mm/dd/yyyy)
Daytime Phone (Area Code and Number)
5.
Address
Street address or box number
6.
7.
8.
City
State/Country
Zip Code
9.
Are you married, even if separated from your spouse?
Yes
No
(Go on to Item 10.)
(Skip to Section IV.)
10.
Spouse’s Social Security Number
–
–
(Required only if Item 17 or 21 is checked)
11.
Spouse’s Name
Last
First
Middle
II.
We must notify your spouse of your request for a partial withdrawal.
FOR MARRIED
12.
Is your spouse’s address the same as above?
Yes
No
(Skip to Section IV.)
(Complete Items 13 – 17.)
CSRS
PARTICIPANTS
13.
Spouse’s Address
ONLY
14.
15.
16.
City
Zip Code
State/Country
17.
Check here if you do not know your spouse’s address.
Your spouse must consent to a partial withdrawal from your TSP account by completing Items 18 and 19. Your
III.
spouse’s signature must be notarized.
FOR MARRIED
FERS
18.
Spouse: By signing below, I give my consent to this partial withdrawal from my spouse’s Thrift Savings Plan
PARTICIPANTS
account. I understand that any amounts disbursed from the account will not be available for the purchase of a
ONLY
joint and survivor annuity when the remainder of the account is disbursed.
19.
Spouse’s Signature
Date Signed
20.
Notary: On this
day of
,
, the person who signed Item 18,
Month
Year
who is known to or was identified by me, personally appeared and acknowledged to me that he or she
signed this form. In witness thereof, I have signed below on this date.
[seal]
My commission expires:
Notary Public’s Signature
Jurisdiction
21.
Participant:
Check here if you cannot obtain your spouse’s signature. (See back of form.)
IV.
Enter a whole dollar amount in Item 22. It must be $1,000 or more. Complete Item 23 if you want to transfer all or
any portion of your withdrawal to a traditional IRA, eligible employer plan, or Roth IRA. (See instructions.) Use a
PARTIAL
whole number to indicate the percentage you want transferred. If you do not want to transfer any portion of your
WITHDRAWAL
withdrawal, skip to Section VII, and sign and date Section VIII.
REQUEST
22.
I would like to make a partial withdrawal of $
.00 from my TSP account.
23.
Transfer
.0 % of the amount in Item 22 to a traditional IRA, eligible employer plan, or Roth IRA.
(Go on to
Section V.)
Form TSP-77 (2/2010)
PREVIOUS EDITIONS OBSOLETE
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