Kalamazoo County, MI · Kalamazoo County
Beneficiary Designation Form
Kalamazoo County employees use this form to designate a spouse to receive pension benefits if they die before retirement.
At a glance
- Issued by
- City of Kalamazoo County · Kalamazoo County, Kalamazoo County, Michigan
- Notarization
- Not required: file this form without a notary.
- Official source
- kalcounty.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This form directs the Kalamazoo County Employees' Retirement System to pay pension benefits to the member's spouse if the member dies before retirement. It asks for the member's Social Security number, the spouse's identifying and contact information, and the member's signature and date. Beneficiary changes require supporting records listed on the form.
Who needs it
Kalamazoo County Employees' Retirement System members who want to designate a spouse or update a beneficiary should complete this form.
How to submit it
Return the original form with required documentation to the County of Kalamazoo Human Resources Department, 201 West Kalamazoo Avenue, Kalamazoo, MI 49007.
About notarization
This form is signed and dated without a notary; it lists supporting records for beneficiary changes but no sworn or notarized attachment.
How to submit this form
- 1
Download the Form
Download the Beneficiary Designation Form.
- 2
Complete the Form
Enter the requested member and spouse information, then sign and date the form.
- 3
Gather Required Records
For a beneficiary change, include the supporting records specified on the form.
- 4
Return the Original
Send the original form and required documentation to the County of Kalamazoo Human Resources Department at the listed address.
Frequently asked questions
- What does the Beneficiary Designation Form do?
- It directs the Kalamazoo County Employees' Retirement System to pay pension benefits to the member's spouse if the member dies before retirement.
- Do I need a notary for the Beneficiary Designation Form?
- No. The member signs and dates the form; it does not call for a notary. Required supporting records for beneficiary changes are listed on the form.
- How do I submit the Beneficiary Designation Form?
- Return the original form with required documentation to the County of Kalamazoo Human Resources Department at 201 West Kalamazoo Avenue, Kalamazoo, MI 49007.
- What documents are required for a beneficiary change?
- For a new spouse, submit a copy of the marriage license and spouse's birth certificate. For divorce or a spouse's death, submit a copy of the divorce decree and spouse's death certificate.