PERA Refund Beneficiary Form

1. PERA Refund Beneficiary Form Important Information You Should Know About Completing a PERA Refund Beneficiary Form Public Employees Retirement Association of New Mexico

2. Frequently Asked Questions • A one-time refund benefit is paid by PERA in the event of your non-duty death. • You may only choose either one person or one organization as your Refund Beneficiary. • If you and your beneficiary pass away at the same time your account (your member contributions and the interest) will be refunded to your estate. Public Employees Retirement Association of New Mexico

3. Member Information Section 999-99-9999 01/01/1960 Mary Smith X 505-222-1234 P. O. Box 111 X Albuquerque NM 87000 X Public Employees Retirement Association of New Mexico

4. Beneficiary Information Section P. O. Box 111, Albuquerque, NM 87000 505-222-1234 OR Spouse 02/02/1959 John Smith 888-88-8888 The Organization’s Name Address / Telephone Number 123-45-6789 John Smith Mary Smith The Organization’s Name January 1, 2008 John Smith Public Employees Retirement Association of New Mexico

5. Member Authorization Section Mary Smith 01/01/2008 Santa Fe January 2008 Mary Smith 1 06/10/2010 505-123-1234 Maria Trujillo Public Employees Retirement Association of New Mexico

6. Completing the Form • Once you have completed the form: • Make a copy for yourself, • Give a copy to your employer, and • Send the original form to PERA. • You may check the PERA website www.pera.state.nm.us after 4 - 6 weeks to see if your beneficiary information has been added/changed. • If you have any questions concerning this form or any other issue, please contact PERA at 1-800-342-3422. Public Employees Retirement Association of New Mexico