1989-13578-Resolution No. 89-036 Recorded 6/8/1989d
89-13578
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BEFORE THE BOARD OF COUNTY COMMISSIONERS OF DESCHUTES t.uuriit, uru uiv
A Resolution Approving *
the Fourth Amendment to *
the Deferred Compensation*
Plan for Deschutes County*
Employees.
RESOLUTION NO. 89 -036
0095 1 666
WHEREAS, Deschutes County adopted a deferred compensation
plan by Resolution No. 84 -001; and
WHEREAS, the Board of County Commissioners having considered
and approved participation by plan participants in the North
American Security Life Venture Annuity Contract; now, therefore,
BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF
DESCHUTES COUNTY, OREGON, as follows:
Section 1. That the Fourth Amendment to the Deferred
Compensation Plan for Deschutes County Employees, marked
Exhibit "A," attached hereto and by this reference incorporated
herein, is hereby approved.
Section 2. That the Administrator is hereby authorized to
execute for the County individual participation and to execute
such agreements and contracts as are necessary under the program.
DATED this 7tn day of
, 1989.
BOARD OF COUNTY COMMISSIONERS
OF SCHUES CO 41 , OREGON
Air A
LOIS : ' I3TO1 'RANTE
/ .0 OPJ osnmissioner
Recording Secretary D MAUDLIN, Commissioner
Chair
1 - RESOLUTION NO. 89 -036
its�l i' li LU
JUN 1 1989
J
0095 1667
EXHIBIT "A"
FOURTH AMENDMENT TO
DEFERRED COMPENSATION PLAN
FOR
DESCHUTES COUNTY EMPLOYEES
1. This Second Amendment amends the Deferred Compensation Plan
for Deschutes County employees adopted January 11, 1984,
(the "Plan "), and the terms used in the plan shall have the
same meaning in this Second Amendment.
2. The Participation Agreement or Consent to Compensation
Change Form is amended as set forth in Exhibit "1," attached
hereto and by this reference incorporated herein.
1 - SECOND AMENDMENT TO DEFERRED COMPENSATION PLAN
EXHIBIT "1"
PARTICIPATION AGREEMENT OR
CONSENT TO COMPENSATION CHANGE
0095 1668
Social Security No.
Name of Public Employee Sex DOB
Address City State Zip
Employer Division or Department
I have read the attached Deschutes County Deferred Compensa-
tion Plan (Plan).
Deferral of Compensation or Chancre of Amount
I wish to have a portion of my compensation deferred under
the Plan until I terminate service with Deschutes County.
I wish to begin deferring compensation as of the day
of , 19
Subject to the limits stated in the Plan, I want to defer:
$ each pay period as follows:
Total
$ To John Hancock Mutual Life
$ To Great West Life
$ To Benjamin Franklin Savings and Loan
$ To Lincoln National Life
(American Funds Group)
$ To Nationwide Life Insurance Co.
$ To North American Security Life
Venture Annuity Contract
I request that the amount of compensation I elected to defer
with said agreement be paid to me pursuant to the terms of the
Plan.
Selection of Option
I wish to elect the following form of payment pursuant to
the Plan:
1 - PARTICIPATION AGREEMENT OR CONSENT TO COMPENSATION CHANGE
Single Lump Sum Payment 0095 169
Payment for a Specified Period
Life Annuity
Life Annuity with Period Certain Guaranteed
Joint and Survivor Annuity
Desianation or Chancre of Beneficiary
In the event of my death, when and if a beneficiary is
entitled to receive my benefits under this Plan, I designate the
following person as my beneficiary.
Name of Beneficiary:
Relationship to me, if any:
Street Address:
I realize that this Agreement will continue to be effective
until I elect in writing to stop deferring compensation or the
County amends or terminates the Plan.
If I elect to stop deferring compensation, I must file a
written election to discontinue deferral with the Administrator
before the beginning or the first pay period for which I wish no
compensation to be deferred.
Election to Discontinue Deferral of Compensation
I elect to stop deferral of my compensation effective on the
day of , 19
Agreed this day of
State
Signed:
Participant
Acknowledgment of Receipt by Employer:
Signature
Title
Date
, 19 , at
City
2 - PARTICIPATION AGREEMENT OR CONSENT TO COMPENSATION CHANGE