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301 CalSavers (Rev. 6/2019) ©2019 Ascensus, LLC
3. IRA OWNER SIGNATURE
I understand that I may replace my beneficiary designations at any time by completing and delivering the proper form to CalSavers. Neither the
IRA custodian nor CalSavers has provided tax or legal advice to me regarding my beneficiary designations.
I designate the individuals or entities named above as my primary and/or contingent beneficiaries of this IRA. I hereby revoke all prior beneficiary
designations, if any, made by me.
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Signature of IRA Owner Date (mm/dd/yyyy)
4. SPOUSAL CONSENT
Skip this section unless you live in one of the following states: Alaska, Arizona, California, Idaho, Louisiana, Nevada, New Mexico,
Texas, Washington, or Wisconsin. If you reside in one of these states, are married at the time of your death, and designate someone other
than or in addition to your spouse, you must obtain your spouse’s consent or your IRA may be payable to your spouse upon your death.
CURRENT MARITAL STATUS
I Am Not Married – I understand that if I become married in the future, I should review the requirements for spousal consent.
I Am Married – I understand that if I choose to designate a primary beneficiary other than or in addition to my spouse, my spouse may need
to sign below.
CONSENT OF SPOUSE
I am the spouse of the above-named IRA owner. I acknowledge that I have received a fair and reasonable disclosure of my spouse’s property
and financial obligations. Because of the important tax consequences of giving up my interest in this IRA, I have been advised to see a qualified
tax professional.
I hereby relinquish any interest that I may have in this IRA and consent to the beneficiary designation indicated above. I assume full responsibility
for any adverse consequences that may result. Note: Do not sign below until you are in the presence of the authorized notary providing the
notary service.
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Signature of Spouse Date (mm/dd/yyyy)
(Your signature must be notarized. See below. We cannot accept a signature guarantee in place of a notary’s seal.)
STATE OF
ss.:
COUNTY OF
This document was acknowledged before me on (date) by (name of
Spouse), who certifies the correctness of the signature of such spouse.
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Signature of Notary Public Date (mm/dd/yyyy)
Notary Public’s Name (First, Middle Initial, Last)
My commission expires:
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Date (mm/dd/yyyy)
Notary to Place Seal Here