Tulare County · California

Defined Contribution

Picture of The Auditor-Controller Treasurer-Tax Collector of Tulare County, Cass Cook

Cass Cook

•  Plan Administrator

Defined Contribution:


Stephanie Henry, Retirement Plan Advisor

(559) 967-2280

Email: Stephanie.henry@empower-retirement.com


Other 457 Forms

Direct Deposit Change Form

You should use this form if you want your distribution from the plan to go as a direct deposit to your saving or checking account.  If the deposit is going to your checking account, please provide a voided check with this form.  If the deposit is going to your savings account,  your request will need to accompany a letter from your financial institution receiving the deposit, on their letterhead, indicating your name, your address, your SSN and the routing number and account number for your checking account.

Enrollment Form

Use this form to do your initial enrollment into the plan.  You should not submit this form again after your initial enrollment into the plan.

Other 457 Online Forms

In-Plan Roth Rollover Request Form


Beneficiary Form

Use this form if you are a participant to indicate who should receive your account balance if you die before fully liquidating your account.  California is a community property state so married participants should name their spouse as 100% primary beneficiary.

Contribution Election Form

Use this form if you need to change the amount you are contributing through payroll.  Also use this form if you are electing to use the special catch-up election.  The table attached to this form should be completed in full to document that you are eligible for the special catch-up, and you should provide you selection of your normal retirement year.  If you are a participant making normal deferrals under age 50 or using the age 50 Catch-up election, you should make your changes electronically on the website or you should call the Empower Customer Service Center to increase, decrease, stop or restart your contribution amounts.

Incoming Rollover Form

Use this form if you are rolling money from a prior 401(k), 401(a), 403(b), IRA, or any other qualified pension program into the Tulare County program.

Personal Information Change Form

You should use this form if you are making changes to your name, your date of birth, your marital status, your gender, or your social security number.  Address changes can be made on this form if you no longer work for Tulare County.  If you are still employed by Tulare County, update your address with the payroll department at the County and they will send the updated address to Empower.

Purchase of Service Credit Request Form

Use this form when you are requesting a transfer to purchase permissible service credits with your employer's governmental defined benefit plan.