Form PERS-BSD-1961 "Request for Payment of Monthly Allowance to a Trust" - California

What Is Form PERS-BSD-1961?

This is a legal form that was released by the California Public Employees' Retirement System - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2019;
  • The latest edition provided by the California Public Employees' Retirement System;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form PERS-BSD-1961 by clicking the link below or browse more documents and templates provided by the California Public Employees' Retirement System.

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Download Form PERS-BSD-1961 "Request for Payment of Monthly Allowance to a Trust" - California

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Request for Payment of Monthly Allowance to a Trust
888 CalPERS (or 888-225-7377) • TTY: (877) 249-7442
Complete this form only if you are requesting that a monthly benefit be paid to a trust where you (or you and
your spouse) are the sole beneficiary during your lifetime. Review the last page of this form for information
and detailed instructions.
Annuitant's Information
Section 1
CalPERS ID
Annuitant's Name (First Name, Middle Initial, Last Name)
(
)
Daytime Phone
Addr ess
Zip
Sta te
Cit y
Payment Preference
Section 2
I authorize CalPERS to send my monthly allowance to the trust by:
 Direct Deposit (You or, if you are not the trustee of the trust, your trustee must complete
Please select one
and submit a Direct Deposit Authorization form.)
box only.
 Paper Check (Provide mailing information below.)
Address for Mailing of Check
Zip
City
State
Annuitant's Certification
Section 3
authorize the California Public Employees'
I,
Annuitant's Name
Retirement System (CalPERS) to pay my monthly allowance to my trust as indicated in Section 2.
Name and Date of Trust
Name of Trustee(s)
Trust's Taxpayer Identification Number
I/We have attached the following required document:
 Certification of Trust for my trust agreement
Section 3 continues on page 2
PERS-BSD-1961 (rev. 02/2019)
Page 1 of 2
Request for Payment of Monthly Allowance to a Trust
888 CalPERS (or 888-225-7377) • TTY: (877) 249-7442
Complete this form only if you are requesting that a monthly benefit be paid to a trust where you (or you and
your spouse) are the sole beneficiary during your lifetime. Review the last page of this form for information
and detailed instructions.
Annuitant's Information
Section 1
CalPERS ID
Annuitant's Name (First Name, Middle Initial, Last Name)
(
)
Daytime Phone
Addr ess
Zip
Sta te
Cit y
Payment Preference
Section 2
I authorize CalPERS to send my monthly allowance to the trust by:
 Direct Deposit (You or, if you are not the trustee of the trust, your trustee must complete
Please select one
and submit a Direct Deposit Authorization form.)
box only.
 Paper Check (Provide mailing information below.)
Address for Mailing of Check
Zip
City
State
Annuitant's Certification
Section 3
authorize the California Public Employees'
I,
Annuitant's Name
Retirement System (CalPERS) to pay my monthly allowance to my trust as indicated in Section 2.
Name and Date of Trust
Name of Trustee(s)
Trust's Taxpayer Identification Number
I/We have attached the following required document:
 Certification of Trust for my trust agreement
Section 3 continues on page 2
PERS-BSD-1961 (rev. 02/2019)
Page 1 of 2
Put the annuitant's name
and CalPERS ID at the
top of every page.
Annuitant's Name
CalPERS ID
Annuitant's Certification, continued
Section 3,
continued
Should I (or, if I am not the trustee of the trust, my trustee) become incapacitated, resign as trustee of
my trust, or otherwise cease to act as trustee of my trust, my successor trustee(s) must complete and
submit the Certification of Trust and Request for Continued Payment of Monthly Allowance to a Trust
form. In addition, CalPERS will request from my successor trustee(s) verification that the successor
trustee(s) has been legally and properly appointed. If I (or, if I am not the trustee of the trust, my
trustee) resign as trustee, I am aware a signed statement of resignation must be provided to
CalPERS.
I understand that monies paid by CalPERS to this trust after my date of death must be returned to
CalPERS. My trustee and successor trustee(s) have been notified of their responsibility to notify
CalPERS immediately upon my death and of their obligation to repay any monies to which CalPERS
is entitled.
I certify that the above-named trust is a revocable living trust and I or I and my spouse are the sole
beneficiaries of this trust during my/our lifetime(s).
I certify under Penalty of Perjury that all the information on this form is true and correct.
Signature and
date required.
Date
Annuitant's Signature
CalPERS Benefit Services Division • P.O. Box 942711, Sacramento, California 94229-2711
Mail to:
PERS-BSD-1961 (rev. 02/2019)
Page 2 of 2
Request for Payment of Monthly Allowance to a Trust Information and Instructions
Information
If you establish a revocable living trust of which either you or you and your spouse are the sole beneficiaries
during your lifetime, CalPERS may pay your monthly allowance to that trust.
CalPERS can only pay a monthly allowance to a trust that was established for your benefit during your lifetime.
CalPERS cannot honor a request to have your monthly allowance paid to a trust for the benefit of another
person (e.g., a trust for the benefit of a grandchild). This is considered an assignment of benefits and is
prohibited by Government Code § 21255.
Should you (or, if you are not the trustee of the trust, your trustee) become incapacitated or if you are
otherwise no longer designated as the trustee of your trust, your successor trustee(s) must complete and
submit the Certification of Trust and Request for Continued Payment of Monthly Allowance to a Trust form. In
addition, your successor trustee(s) must provide written verification that he or she has been properly appointed
as successor trustee.
Pursuant to Government Code § 21256, the trustee(s) have the authority to make tax withholding elections
and to change the address for annuitant payments and payment-related correspondence. Submission of a
power of attorney that confers authority related to CalPERS or conservatorship is required if changes to your
account other than the those specified in Government Code § 21256 are requested by your trustee.
The trustee must reimburse any monies paid to the trust after your death.
It is recommended that you retain a copy of this form and keep it with the trust document.
Annuitant's Information
Section 1
 You must complete all fields.
Section 2
Payment Preference
 Select a checkbox to indicate how CalPERS should send your monthly allowance.
 If you select direct deposit, you (or, if you are not the trustee of the trust, your trustee)
must complete and sign the Direct Deposit Authorization
 If you select paper check, provide the address for mailing of the check.
Section 3
Annuitant's Certification
 You must complete all fields, sign and date this form.
 You must attach the Certification of Trust from the trust agreement.
 If you are completing this form as an attorney-in-fact pursuant to a power of attorney
designation, you must submit a validly-executed and currently effective power of attorney
document with this form.
PERS-BSD-1961 (rev. 09/2018)
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