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The forms here will change beneficiaries on various County benefits. If you are changing due to a dependent status change, please also see the Dependent Change page, as there are additional forms that must be completed.
Base Life This $10,000 base life insurance policy is provided for all regular full-time employees. Regular part-time employees may participate by paying a pro-rated portion of the premium. Complete, sign, date and return the base life change form to the Human Resources Department.
Supplemental Life - If you participate in this voluntary program; complete, sign, date and return the supplemental life change form to the Human Resources Department.
Retirement - The Beneficiary Designation Form allows you to change the beneficiary(ies) for your retirement funds (PERS and LEOFF); as well as the $150,000 survivor benefit. Complete, sign and date the form which can then either be returned to the Human Resources Department, or sent directly to the Department of Retirement Systems at:
WA State DRS
PO Box 48380
Olympia WA 98504-8380
Deferred Compensation - If you are a participant of ICMA, use the ICMA change form to make your changes. If you are a participant of ING, use the ING change form to make your changes. Complete, sign, date and return the appropriate change form(s) to the Human Resources Department.
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