(1)The
following statutory form shall be the standard form for a designated beneficiary
agreement:
DESIGNATED BENEFICIARY AGREEMENT
______________________________________________________________
DISCLAIMER
Warning: While this document may indicate your wishes, certain additional
documents may be needed to protect these rights.
This designated beneficiary agreement is operative in the absence of other estate
planning documents and will be superseded and set aside to the extent it
conflicts with valid instruments such as a will, power of attorney, or beneficiary
designation on an insurance policy or pension plan. This designated beneficiary
agreement is superseded by such other documents and does not cause any
changes to be made to those documents or designations. The parties u
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(1) The
following statutory form shall be the standard form for a designated beneficiary
agreement:
DESIGNATED BENEFICIARY AGREEMENT
______________________________________________________________
DISCLAIMER
Warning: While this document may indicate your wishes, certain additional
documents may be needed to protect these rights.
This designated beneficiary agreement is operative in the absence of other estate
planning documents and will be superseded and set aside to the extent it
conflicts with valid instruments such as a will, power of attorney, or beneficiary
designation on an insurance policy or pension plan. This designated beneficiary
agreement is superseded by such other documents and does not cause any
changes to be made to those documents or designations. The parties understand
that executing and signing this agreement is not sufficient to designate the other
party for purposes of any insurance policy, pension plan, payable upon death
designation or manner in which title to property is held and that additional action
will be required to make or change such designations. The parties understand
that this designated beneficiary agreement may be one component of estate
planning instructions and that they are encouraged to consult an attorney to
ensure their estate planning wishes are accomplished.
______________________________________________________________
We, _______________, (insert full name and address) referred to as party A, and
_______________, (insert full name and address) referred to as party B, hereby
designate each other as the other's designated beneficiary with the following rights
and protections, granted or withheld as indicated by our initials:
TO GRANT ONE OR MORE OF THE RIGHTS OR PROTECTIONS SPECIFIED IN THIS
FORM, INITIAL THE LINE TO THE LEFT OF EACH RIGHT OR PROTECTION YOU ARE
GRANTING. TO WITHHOLD A RIGHT OR PROTECTION, INITIAL THE LINE TO THE
RIGHT OF EACH RIGHT OR PROTECTION YOU ARE WITHHOLDING.
A DESIGNATED BENEFICIARY AGREEMENT SHALL BE PRESUMED TO GRANT ALL
OF THE RIGHTS AND PROTECTIONS LISTED IN THIS FORM UNLESS THE PARTIES
WITHHOLD A RIGHT OR PROTECTION IN THE MANNER SET FORTH IMMEDIATELY
ABOVE.
TO GRANT A RIGHT
TO WITHHOLD A RIGHT OR PROTECTION
OR PROTECTION INITIAL
INITIAL
Party A Party B Party A Party B ___ ___ The right to acquire,
hold title to, own___ ___ jointly, or transfer inter vivos or at death real or
personal property as a joint tenant with me with right of survivorship or as a
tenant in common with me; ___ ___ The right to be designated by me as a ___
___ beneficiary, payee, or owner as a trustee named in an inter vivos or
testamentary trust for the purposes of a nonprobate transfer on death; ___
___ The right to be designated by me as a ___ ___ beneficiary and
recognized as a dependent in an insurance policy for life insurance; ___ ___
The right to be designated by me as a ___ ___ beneficiary and recognized as
a dependent in a health insurance policy if my employer elects to provide
health insurance coverage for designated beneficiaries; ___ ___ The right to
be designated by me as a ___ ___ beneficiary in a retirement or pension plan;
___ ___ The right to petition for and have ___ ___ priority for
appointment as a conservator, guardian, or personal representative for me; ___
___ The right to visit me in a hospital, ___ ___ nursing home, hospice, or
similar health care facility in which a party to a designated beneficiary
agreement resides or is receiving care; ___ ___ The right to initiate a formal
___ ___ complaint regarding alleged violations of my rights as a nursing
home patient as provided in section 25-1-120, Colorado Revised Statutes; ___
___ The right to act as a proxy ___ ___ decision-maker or surrogate
decision-maker to make medical care decisions for me pursuant to section
15-18.5-103 or 15-18.5-104, Colorado Revised Statutes; ___ ___ The right to
notice of the withholding ___ ___ or withdrawal of life-sustaining procedures
for me pursuant to section 15-18-107, Colorado Revised Statutes; ___ ___
The right to challenge the validity of ___ ___ a declaration as to medical or
surgical treatment of me pursuant to section 15-18-108, Colorado Revised
Statutes; ___ ___ The right to act as my agent to make, ___ ___ revoke, or
object to anatomical gifts involving my person pursuant to the Revised
Uniform Anatomical Gift Act, part 2 of article 19 of title 15, Colorado
Revised Statutes; ___ ___ The right to inherit real or personal ___ ___
property from me through intestate succession; ___ ___ The right to have
standing to receive ___ ___ benefits pursuant to the Workers' Compensation
Act of Colorado, article 40 of title 8, Colorado Revised Statutes, in the
event of my death on the job; ___ ___ The right to have standing to sue for ___
___ wrongful death in the event of my death; and ___ ___ The right to direct
the disposition of ___ ___ my last remains pursuant to article 19 of title 15,
Colorado Revised Statutes.
THIS DESIGNATED BENEFICIARY AGREEMENT IS EFFECTIVE WHEN RECEIVED
FOR RECORDING BY THE COUNTY CLERK AND RECORDER OF THE COUNTY IN
WHICH ONE OF THE DESIGNATED BENEFICIARIES RESIDES. THIS DESIGNATED
BENEFICIARY AGREEMENT WILL CONTINUE IN EFFECT UNTIL ONE OF THE
DESIGNATED BENEFICIARIES REVOKES THIS AGREEMENT BY RECORDING A
REVOCATION OF DESIGNATED BENEFICIARY FORM WITH THE COUNTY CLERK
AND RECORDER OF THE COUNTY IN WHICH THIS AGREEMENT WAS RECORDED
OR UNTIL THIS AGREEMENT IS SUPERSEDED IN PART OR IN WHOLE BY A
SUPERSEDING LEGAL DOCUMENT.
___________________________ _____________________________ Signature of
designated beneficiary Signature of designated beneficiary
STATE OF COLORADO
County of ______________ This document was acknowledged before me on
___________date
by
________________________
My commission expires ______________
[Seal]
_______________________________ Notary Public
(2) The instructions to each party regarding how to grant or withhold a right
or protection by initialing and the words Party A and Party B shall appear at the
top of each page of the statutory form above the columns for the initials of the
designated beneficiaries.
(3) A designated beneficiary agreement shall be presumed to extend all of
the rights and protections listed in the statutory form unless the parties to the
agreement explicitly exclude a right or protection.
(4) A party to a designated beneficiary agreement may limit the scope of a
designated beneficiary agreement by the terms of the agreement or by executing a
superseding legal document that controls and supersedes part or all of the
designated beneficiary agreement.