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Public Employee Retirement System of Idaho
P. O. Box 83720, Boise, ID 83720-0078
1-800-451-8228 • 208-334-3365 • Fax 208-334-3805
www.persi.idaho.gov • email@example.com
About Form RS115
1 Complete the form and sign in blue or black ink.
2 Use whole percentages only.
3 If more space is needed, attach an additional signed and dated sheet of paper.
4 If any designated beneficiary is a minor, complete page 2 if you choose to nominate an adult custodian to receive
the funds for the minor. PERSI cannot pay a death benefit directly to a minor beneficiary.
5 Send the form to PERSI.
Note: The form is not valid unless signed, dated, and on file with PERSI.
Primary beneficiary or beneficiaries. The first person or persons to receive death benefits when you die. If you
select one person only, he or she receives 100% of the benefits.
• Secondary beneficiary or beneficiaries. Person or persons to receive death benefits if no primary beneficiary or
beneficiaries are alive when you die.
• Default beneficiary. If PERSI does not have a beneficiary designation on file, death benefits are paid by law to
the following: (1) To your surviving spouse. (2) If you have no surviving spouse, to your estate. If you agree with
this default distribution and you have not previously submitted a beneficiary designation form, you do not need to
designate a beneficiary or submit this form. However, payment of death benefits could be delayed if PERSI has no
designation on file.
Notes About Designating Beneficiaries
Percentages must be in whole numbers. Do not use partial numbers. For example, use 33% not 33⅓%.
• Choose your beneficiaries carefully. Your PERSI funds might be your largest financial asset.
• If you select two or more people as primary or secondary beneficiaries, indicate what percentage each is to receive
(the percentages must equal 100%).
• You must list your children separately.
• If you are designating one or more minors as beneficiary, you should specify how you want your death benefit
transferred if you die before the beneficiary reaches legal age of majority. PERSI cannot disburse the money to a
minor, so if you don’t nominate a custodian on this form, a court may have to appoint an adult to serve as
conservator of the funds. This form provides an easy and inexpensive way to transfer death benefits to a minor
through the Idaho Uniform Transfers to Minors Act (UTMA). This law enables you to nominate a custodian, and
substitute custodian, for your minor beneficiary, and authorizes PERSI to pay your death benefit to the custodian.
To nominate a custodian for a minor beneficiary, fill out page 2 of this form.
• If you use the UTMA to nominate a custodian for your minor beneficiary, be aware that the legal age of majority
under the UTMA is 21, even though the statutory age of majority in Idaho is 18. If you die before your beneficiary
is 21 years of age, the money will go to and remain in the custodian’s care until the beneficiary reaches age 21.
• Always provide full names (Mary Elizabeth Smith, not Mary Smith). For a married woman, use her full name (Mary
Elizabeth Smith, not Mrs. Bob Smith). Include the relationship to you.
• This beneficiary designation is for PERSI Base Plan and Choice 401(k) Plan death benefits only. Any designations
you make for a will or an insurance policy do not substitute for the PERSI beneficiary designation.
• Submit a new Beneficiary Designation (RS115) to PERSI if your marital status changes.
• Complete a Member Name Change (RS111) if your name changes. If you are an active member, (working for a
PERSI employer and making contributions) give the form to your payroll clerk. If not, send the form to PERSI.
• You can change your designations at any time by submitting a new Beneficiary Designation (RS115) to PERSI.
• If you make an error, initial and date any corrections.