(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estate planning documents and will be superseded and set aside to the extent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designated beneficiary agreement is superseded by such other documents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
OR PROTECTION
INITIAL
PARTY A PARTY B
TO WITHOLD A RIGHT
OR PROTECTION
INITIAL
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;
__
__
__
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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;
__
__
__
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The right to
have standing to
sue for
wrongful death
in the event of
my death; and
__
__
__
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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.
Source: L. 2009: Entire article added, (HB 09-1260), ch. 107, p. 433, § 1, effective July 1. L. 2010: Entire section amended, (SB 10-199), ch. 374, p. 1754 § 23, effective July 1. L. 2017: (1) amended, (SB 17-223), ch. 158, p. 560, § 15, effective August 9.