Tulare County · California
Defined Contribution
Email: arturo.mendezvega@empower.com
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 Any money withdrawn as a death benefit will be reported as ordinary income in the year of receipt.
Use this form if you are a participant who is an active employee with an account balance not in excess of $5,000, you have not previously received an in-service distribution, and no amount has been deferred under the plan with respect to the participant during the two-year period ending on the date of the in-service distribution.
Use this form when you are requesting a withdrawal and you are no longer employed by Tulare County.
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.
Use this form if you are a former County of Tulare employee and you are retired under the IRS definition of Full and Permanent Disability. This form will have to be signed by both you and your physician and you are both verifying under penalty of perjury that you meet the IRS definition of Full and Permanent Disability. This form must be submitted with the Separation from Service Withdrawal 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.
