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alterations without initials an incomplete form or any attempt to change its provisions an unacceptable designation Supplemental Death Benefits Beneficiary Designation TMRS Please use only black ink and do not highlight. Any corrections or whiteouts must be initialed. MEMBER INFORMATION Social Security Number Your Name (first, middle, last) – Mailing Address – Daytime Phone Number ( City State Zip Code ) – Employing City Name: – DESIGNATING YOUR PRIMARY SDB BENEFICIARY.

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