Tulare County · California

Defined Contribution

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

Cass Cook

•  Plan Administrator

Defined Contribution:

 

Katerina Soto, Retirement Plan Advisor

(559) 967-2280

Email:  katerina.soto@empower.com


 

3121 Distribution Forms

3121 Death Benefit Withdrawal Form

Use this form if you are a Beneficiary or an Executor of an Estate when a participant has died.  If there are multiple beneficiaries, each beneficiary should fill out their own form indicating their portion of the account balance they are applying for which will be verified by Tulare County.  Any money withdrawn as a death benefit will be reported as ordinary income in the year of receipt.

3121 In-service Withdrawal Request Form

Use this form when you are requesting a withdrawal and you are still employed by the employer/company sponsoring this Plan.

3121 Separation from Employment Withdrawal Form

Use this form when you are requesting a withdrawal and are no longer employed by the employer/company sponsoring this Plan.

Online 3121 Distribution Forms

 

3121 Alternate Payee Distribution Request Form

Use this form to take distributions out of your account when you are not and have not been a County of Tulare Employee, but have had an account established for you as part of a Qualified Domestic Relations Order.

 

3121 Disability Withdrawal Request Form

Use this form when you are requesting a withdrawal due to your disability or making a change to an existing periodic installment payment due to disability.