Today's Date

(Before filling out the "DESIGNATION OF BENEFICIARY" section, please see instructions.

Your Account Number E-mail address:

Are you married? Yes No
If No, enter name of beneficiary(ies). If Yes, and your spouse is your beneficiary, please input spouse's name here . If your spouse will not be named as your beneficiary, please fill out and print this form, have both you and your spouse sign where indicated, then return form to the Credit Union.

Member Information
Plan Number	Code
Soc. Sec. #	IRA Suffix		IRA Owner's Name

[] I am the beneficiary. (Check this box if your are not the original owner of this account, but instead received it as the designated beneficiary and are now designating your own beneficiaries.)

DESIGNATION OF BENEFICIARY (revocable)
PRIMARY Beneficiary(ies)
%	Name	Mailing Address	Relationship	Birth Date	SS#
% Column MUST total 100%

SECONDARY Beneficiary(ies)
%	Name	Mailing Address	Relationship	Birth Date	SS#
% Column MUST total 100%

TERTIARY Beneficiary(ies)
%	Name	Mailing Address	Relationship	Birth Date	SS#
% Column MUST total 100%

(This beneficiary designation overrides all previous designations for the IRA. If you have more than one IRA, you must fill out a separate Beneficiary Designation/Change Form for each IRA.)

CONSENT OF SPOUSE

I consent to the designation of beneficiary on this form; and I agree to convert this IRA into the separate property of my spouse to be distributed as shown on this form following my spouse's death. I understand that by signing this consent, I am giving up both my current community/marital property rights in the IRA and my community/marital property rights in any future contributions to this IRA. I further understand that I may not revoke this consent in the future. However, this consent will be automatically revoked if my spouse amends this designation of beneficiary during my lifetime.

X___________________________________ Date___________________ Signature of IRA Owner's Spouse (REQUIRED)

IRA OWNER'S SIGNATURE

(This beneficiary designation is not effective unless signed.)

X___________________________________ Date___________________ IRA Owner's Signature (REQUIRED)

Please print this form and fax to (402) 399-0129, mail to Omaha Federal Credit Union, 3001 So. 82nd Ave., Omaha, Nebraska 68124 or stop by one of our four office locations.