Edit, Download, and Sign the CCCERA Spousal Waiver Form (Rev. 2022)
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How do I fill this out?
When filling out this form, ensure you use blue or black ink and provide all required information. The form must be signed by your spouse or domestic partner, and their signature must be witnessed by a notary. Finally, submit the original document to CCCERA; fax or email copies will not be accepted.
How to fill out the CCCERA Spousal Waiver Form (Rev. 2022)?
1
Complete the form using blue or black ink.
2
Provide your full name, employee number, and last 4 of your Social Security Number.
3
Have your spouse or domestic partner sign the form in the presence of a notary.
4
Ensure the notary fills out and signs the acknowledgement section.
5
Submit the original form to CCCERA at the provided address.
Who needs the CCCERA Spousal Waiver Form (Rev. 2022)?
1
Employees of Contra Costa County who want their spouse to waive survivor benefits.
2
California Registered Domestic Partners seeking to waive survivor benefits.
3
Employees who have not designated their spouse as the sole beneficiary.
4
Participants needing to update their spousal waiver status.
5
Individuals requiring a notarized spousal waiver form for CCCERA.
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What are the instructions for submitting this form?
Complete the form using blue or black ink and ensure all required information is provided. Have your spouse or domestic partner sign the form in the presence of a notary. Submit the original document to CCCERA at 1200 Concord Avenue, Suite 300, Concord, CA 94520. Do not send fax or email copies. For questions, call CCCERA at 925-521-3960 or visit cccera.org. Providing accurate information and adhering to submission guidelines will facilitate the processing of your waiver.
What are the important dates for this form in 2024 and 2025?
Ensure to submit the form as required without delay. Important dates may vary depending on your personal or CCCERA-related deadlines.
What is the purpose of this form?
The CCCERA Spousal Waiver Form is designed for employees of Contra Costa County and California Registered Domestic Partners to waive survivor benefits from CCCERA. It is intended for those who have not named their spouse or domestic partner as the sole beneficiary. By completing and submitting this form, the spouse or partner agrees to waive any survivor benefits upon the participant's death.
Tell me about this form and its components and fields line-by-line.
- 1. Full Name (Employee): Enter the full name of the employee.
- 2. Last 4 of Social Security Number: Provide the last 4 digits of the employee's Social Security Number.
- 3. Employee #: Enter the employee number.
- 4. Full Name (Spouse): Enter the full name of the spouse or domestic partner.
- 5. Spouse Signature: The spouse or domestic partner must sign here.
- 6. Date: Provide the date of signing in mm/dd/yyyy format.
- 7. Notary Acknowledgment: A section for the notary to complete, including the notary's signature and seal.
What happens if I fail to submit this form?
Failure to submit this form may result in the spouse or partner not waiving their survivor benefits.
- Benefits Distribution: Survivor benefits may still be distributed to the spouse.
- Incomplete Update: Failure to update spousal waiver status could lead to administrative issues.
How do I know when to use this form?
- 1. Spousal Waiver: When a spouse decides to waive their survivor benefits.
- 2. Domestic Partner Waiver: When a California Registered Domestic Partner decides to waive their survivor benefits.
- 3. Beneficiary Update: When the employee has not named their spouse as the sole beneficiary.
Frequently Asked Questions
What is the purpose of the CCCERA Spousal Waiver Form?
The form is used to allow a spouse or California Registered Domestic Partner to waive CCCERA survivor benefits.
How should I fill out the form?
Use blue or black ink, provide all required information, have your spouse or partner sign it in front of a notary, and submit the original document to CCCERA.
Do I need to notarize the form?
Yes, a notary must witness your spouse or partner's signature on the form.
Can I submit a fax or email copy of the form?
No, only the original document will be accepted by CCCERA.
How can I edit the form on PrintFriendly?
Open the PDF in the PrintFriendly PDF editor, make any necessary changes, and save the edited version.
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Yes, you can use the signature tool in our PDF editor to add your digital signature.
How can I share the form on PrintFriendly?
Use the share feature to send the document via email or generate a shareable link.
Who needs to fill out this form?
Employees of Contra Costa County and registered domestic partners who want to waive survivor benefits from CCCERA.
What happens if I don't submit the original form?
Fax or email copies will not be accepted, and you will need to submit the original document to CCCERA.
Where do I send the completed form?
Mail the original completed form to Contra Costa County Employees' Retirement Association, 1200 Concord Avenue, Suite 300, Concord, CA 94520.
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