Beneficiary Change

Please complete and print both forms and send in to Human Resources to process your beneficiary changes. 

Please read before completing the Designation of Beneficiary Form:  This form must be notarized.  Please be sure you do not cross out or use whiteout on this form.  It is best to complete it on the computer and then print it out.  Do not sign this form unless you are in front of a notary.  Our Human Resources Department has two (2) notaries that can notarize your form or you can take it to another notary.  This form must be submitted to the Human Resources Department.


Designation of Beneficiary
- MD State Pension System (notarized form)

Group Insurance Beneficiary Designation/Change
- Prudential Life Insurance