Form Tsp-3 - Designation Of Beneficiary - Thrift Savings Plan Page 4
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4EXAMPLES OF DESIGNATING A BENEFICIARY
(continued)
1.
D.
The XYZ Foundation
Share:
100%
DESIGNATING A
Name [Name of corporation or legal entity]
c/o Eleanor Jarvis, Legal Representative
64730 Connecticut Ave.
CORPORATION
Street address or box number [Name of Legal Representative and Legal Representative’s address]
OR LEGAL
Bethesda
MD
20815
ENTITY
City
State/Country
Zip Code
99-0123456
[Leave blank]
[Leave blank]
Social Security Number/EIN
Date of Birth (mm/dd/yyyy)
Relationship
E.
1.
John P. Manos Trust
Share:
100%
DESIGNATING
Name [Name of trust]
A TRUST
c/o Eric P. Manos, Trustee
1111 Delaware Lane
Street address or box number [Name of Trustee and Trustee’s address]
New York
NY
14607
City
State/Country
Zip Code
92-3456789
[Leave blank]
Trust
Social Security Number/EIN
Date of Birth (mm/dd/yyyy)
Relationship
F.
1.
Share:
Estate of Ruth R. Jones
100%
DESIGNATING
Name [Name of estate]
AN ESTATE
c/o Marilyn D. McClain, Executor
150 Rossmoyne Drive
Street address or box number [Name of Executor and Executor’s address]
Alameda
CA
94510
City
State/Country
Zip Code
93-1234567
Estate
[Leave blank]
Date of Birth (mm/dd/yyyy)
Social Security Number/EIN
Relationship
G.
This will cause your
1.
Cancel prior designations
Share:
account to be paid
CANCELLING A
Name (Last)
(First)
(Middle)
according to the order
DESIGNATION OF
of precedence (unless
BENEFICIARY
you submit another
Street address or box number
Form TSP-3).
City
State/Country
Zip Code
Be sure your form
/
/
cancelling prior designa-
tions is signed, dated, and
Social Security Number/EIN
Date of Birth (mm/dd/yyyy)
Relationship
witnessed.
PRIVACY ACT NOTICE.
We are authorized to request this information under 5
law, or agencies implementing a statute, rule, or order. It may be shared with congres-
U.S.C. chapter 84. Executive Order 9397 authorizes us to ask for your Social Security
sional offices, private sector audit firms, spouses, former spouses, and beneficiaries,
number, which will be used to identify your account. We will use the information you
and their attorneys. We may also disclose relevant portions of the information to ap-
provide on this form to document your choice of beneficiary or beneficiaries to receive
propriate parties engaged in litigation. You are not required by law to provide this
your account after your death. This information may be shared with other Federal
information, but if you do not provide it, we will not be able to document your choice of
agencies for statistical, auditing, or archiving purposes. In addition, we may share the
beneficiary(ies).
information with law enforcement agencies investigating a violation of civil or criminal
Form TSP-3 (10/2005)
EDITIONS PRIOR TO 8/02 OBSOLETE
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