Primary Beneficiary

Name	Last Updated	Relationship	Allocation Percentage
			Total: 100.00%
BLUE, ANGELINA		Mother	100.00

Instructions for Plan Participants

Please print this page and have your spouse complete and sign where indicated. Your spouse's consent to this election must be witnessed by a plan representative or a Notary Public. (If you certified that you are married, but cannot locate your spouse, please print this page and complete and sign where indicated. Your election must be witnessed by a plan representative or a Notary Public. Your plan representative may request evidence of this designation for their records.)

Your beneficiary designation election has been placed in a pending status pending receipt of a notarized (or plan representative witnessed) spousal consent. Within the next 30 days return the completed consent form to:

MICHAEL INDIGO
803 TEST AVE
OSCEOLA WI 54025

If this completed consent form is not received within those 30 days, your designation(s) will be deleted.

Spousal Consent to Beneficiary Designation

I am the spouse of the plan participant named above and understand that my spouse is designating a primary beneficiary other than, or in addition to, myself.

I understand that if the plan gives me the right to revoke this consent that I may do so by delivering to the plan representative a written revocation of this consent prior to the death of my spouse. Upon the death of my spouse the consent contained herein, if not previously revoked, shall be irrevocable.

_________________________ Spouse's Printed Name	_________________________ Spouse's Signature	_________________________ Date
Only needed if participant is married, but unable to locate his or her spouse
_________________________ Participant's Printed Name	_________________________ Participant's Signature	_________________________ Date
Witnessed by:
_________________________ Plan Representative's Signature	_________________________ Date
If NOT Witnessed by a Plan Representative, Notary Public MUST Witness:
Subscribed and sworn before me this __________ day of _______________________, 20_____.
Notary Public ____________________________________________________________
County of Residence _______________________ My Commission Expires _________________________