Form Tsp-3 - Designation Of Beneficiary - Thrift Savings Plan Page 3
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2
3
4EXAMPLES OF DESIGNATING A BENEFICIARY
A.
1.
Share:
Morgan
Katherine
Anne
100%
Enter the full name of the
DESIGNATING
beneficiary. Do not write
Name (Last)
(First)
(Middle)
ONE
name as K.A. Morgan or as
1279 Lake Avenue
Mrs. Keith H. Morgan.
BENEFICIARY
Street address or box number
New Orleans
LA
70124
City
State/Country
Zip Code
ter
923-45-6789
6
/
22
/
1942
Sis
Social Security Number/EIN
Date of Birth (mm/dd/yyyy)
Relationship
B.
¼
1.
Larson
Susan
Maria
Share:
Be sure that the shares to
DESIGNATING
be paid to the beneficiaries
Name (Last)
(First)
(Middle)
total 100 percent if using
MORE THAN ONE
4231 Oregano Street
percentages, or 1 if using
BENEFICIARY
Street address or box number
fractions.
Cincinnati
OH
45239
City
State/Country
Zip Code
ter
934-56-7890
9
7
1950
Sis
/
/
Social Security Number/EIN
Date of Birth (mm/dd/yyyy)
Relationship
¼
2.
Larson
Elliott
Harris
Share:
If you use additional
pages, be sure to put your
Name (Last)
(First)
(Middle)
name, Social Security
4231 Oregano Street
number, and date of birth
Street address or box number
on each page. You and the
Cincinnati
OH
45239
same two witnesses who
signed the form must sign
City
State/Country
Zip Code
each additional page. Put
945-67-8901
4
/
20
/
1952
Brother
the date you signed the
Date of Birth (mm/dd/yyyy)
Social Security Number/EIN
Relationship
form on each additional
page.
½
3.
Share:
Steinway
Sarah
Ruth
Name (Last)
(First)
(Middle)
P.O. Box 812
Street address or box number
Covington
KY
40117
City
State/Country
Zip Code
956-78-9012
12
/
2
/
1960
Friend
Social Security Number/EIN
Date of Birth (mm/dd/yyyy)
Relationship
C.
If living:
1.
Kraus
Michael
Thomas
Share:
100%
You may designate one or
DESIGNATING
more contingent beneficia-
Name (Last)
(First)
(Middle)
ONE OR MORE
ries to receive a beneficia-
6287 Laurel Post Drive
CONTINGENT
ry’s share if the primary
Street address or box number
beneficiary dies before you
BENEFICIARIES
Stone Mountain
GA
30058
do. To identify the primary
and contingent beneficia-
City
State/Country
Zip Code
ries, you must write in ‘‘If
967-89-0123
3
12
1936
Father
/
/
living:’’ above the primary
Date of Birth (mm/dd/yyyy)
Social Security Number/EIN
Relationship
beneficiary’s name and
‘‘Otherwise to:’’ above the
Otherwise to:
contingent beneficiary’s
2.
Share:
Kraus
Cecilia
Jean
50%
name. If there is more than
Name (Last)
(First)
(Middle)
one contingent beneficiary
6287 Laurel Post Drive
for a primary beneficiary,
write in ‘‘And to:’’ above the
Street address or box number
second (and subsequent)
Stone Mountain
GA
30058
beneficiary’s name.
City
State/Country
Zip Code
978-90-1234
8
16
1968
Daughter
/
/
In this example, Melissa
Richardson and Cecilia
Social Security Number/EIN
Date of Birth (mm/dd/yyyy)
Relationship
Kraus are both contingent
And to:
beneficiaries for Michael
3.
Share:
Richardson
Melissa
Anne
50%
Kraus.
Name (Last)
(First)
(Middle)
Note: If a named benefi-
9842 Magnolia Drive
ciary dies, you may prefer
Street address or box number
to submit another Form
Columbus
GA
30161
TSP-3 to change your
designation(s).
City
State/Country
Zip Code
989-01-2345
11
6
1970
Daughter
/
/
Form TSP-3 (10/2005)
Date of Birth (mm/dd/yyyy)
Social Security Number/EIN
Relationship
EDITIONS PRIOR TO 8/02 OBSOLETE
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