Waiver of 30 Day Notice

Waiver of 30 Day Notice Period

Federal law requires the Board of Trustees provide you with a written explanation of the effect of payment of your pension in the form of the Husband-and-Wife Pension or other optional pension forms. This written explanation must be provided to you no earlier than 90 days before and no later than 30 days before your payments begin. However, you may begin receiving payments before the end of the 30 day period if you and your spouse waive the 30 day waiting period.

We, the undersigned, hereby irrevocably waive our rights to the 30-day waiting period and acknowledge that we have received a written explanation from the Board of Trustees describing the effect of payment in the form of a Husband-and-Wife Pension and other optional forms.

Print Name *

Print Name

Participant's Signature

Spouse's Signature

Social Security Number *

Social Security Number

Date *

State of *

County of *

On the

day of

before me came

known to me to be the person(s) described above and who executed the foregoing statement and they duly acknowledged to me that they executed the same.

Notary Public

My Commission Expires *

Waiver of 30 Day Notice Period

Address Info

Hours of Operation