State Form 29211 - Request For Estimate Of Benefits Page 3
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3STEP 3: Anticipated Retirement Beneficiary Information
Please provide the following information for anyone you anticipate naming as beneficiary for one of the joint and survivor options (Options 30,
40, or 50) at retirement. If you do not provide this information, no estimate will be prepared for the joint and survivor options.
Beneficiary’s Social Security Number: Enter all nine digits of your beneficiary’s Social Security Number.
Beneficiary’s Date of Birth: Enter your beneficiary’s date of birth as MM/DD/YYYY.
Beneficiary’s Name: Enter your beneficiary’s first name, middle initial, and last name.
Relationship to Employee: Enter the relationship of your beneficiary to you; e.g. spouse, child, etc.
Member Acknowledgement
Please sign, print your name, and date the form.
Once the form has been completed according to these instructions, return the form (DO NOT return the instructions) to the Public Employees’
Retirement Fund (PERF) at the following address:
Public Employees’ Retirement Fund
143 West Market Street
Indianapolis, IN 46204
MEMBER NOTE – CHANGES TO INFORMATION
If you have any changes to any of the information on this form, such as name, address, beneficiary information, etc., please immediately notify
PERF at the address above so your estimate can be updated.
HELPFUL INFORMATION
PERF
TELEPHONE NUMBERS:
Indianapolis & vicinity (317) 233-4162
Toll-Free Number 1-888-526-1687
TDD (hearing impaired number) (317) 233-4160
FAX Number (317) 232-1614
PERF on the Internet:
PERF MEMBER HANDBOOK (latest edition)
PERF ANNUITY SAVINGS ACCOUNT INVESTMENT HANDBOOK
Internal Revenue Service
TELEPHONE NUMBERS:
Toll-Free Number 1-800-829-1040
TDD (hearing impaired number) 1-800-829-4059
TeleTax 1-800-829-4477
IRS website:
IRS PUBLICATION 575, PENSION AND ANNUITY INFORMATION
IRS PUBLICATION 590, INDIVIDUAL RETIREMENT ARRANGEMENTS
Indiana Department of Revenue (DOR)
TELEPHONE NUMBERS:
Indianapolis & vicinity (317) 233-4018
TDD (hearing impaired number) (317) 233-4952
Individual Income Tax Questions (317) 232-2240
Outside of Indianapolis – See DOR website
DOR FAX Number (317) 233-2329
DOR website:
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