Dd Form 2656 2009

The DD Form 2656-1 Survivor Benefit Plan SBP Election Statement for Former Spouse Coverage must also be completed and accompany the completed DD Form 2656 to DFAS - Cleveland. A. of this document in my presence. Signature of Notary DD FORM 2656 BACK APR 2009 My commission expires NOTARY SEAL Reset. DD FORM 2656 APR 2009 b. DATE OF BIRTH c. SSN e. DISABLED Yes/No MEMBER NAME LAST First Middle Initial SSN It is recommended that you see your Survivor Benefit Plan counselor before making an election. 26. Component not on active duty retiring at age 60. DD FORM 2656 INSTRUCTIONS APR 2009 following criteria 1 you had no Federal income tax liability in the prior year 2 you anticipate no Federal income tax liability this year and 3 you therefore desire no Federal income tax to be withheld from your NOTE You must file a new exemption claim form with DFAS - Cleveland by February 15th of each year for which you claim exemption from withholding. C. Used by a REDUX member who wants coverage based on actual retired pay received under REDUX. If this option is selected proceed to Section XII if married. of your retirement. SECTION X - REMARKS. ITEM 29. Reference each entry by item number. Continue on separate sheets of paper if more space is needed. SECTION XI - CERTIFICATION. Read the statement carefully then sign your name and indicate the date of signature. For your SBP election to be valid you must sign and date the form prior to the effective date of your retirement/transfer. TYPE OF PAYMENT c. GROSS AMOUNT 12. Complete only if a member or former member of the reserve component not on active duty retiring at age 60. ANY VA COMPENSATION FOR DISABILITY X one b. EFFECTIVE DATE OF PAYMENT c. MONTHLY AMOUNT OF PAYMENT 13. Complete this section if you wish to designate a beneficiary or beneficiaries to receive any unpaid retired pay you are due at death. SECTION X - REMARKS. ITEM 29. Reference each entry by item number. Continue on separate sheets of paper if more space is needed. SECTION XI - CERTIFICATION. Read the statement carefully then sign your name and indicate the date of signature. For your SBP election to be valid you must sign and date the form prior to the effective date of your retirement/transfer. A witness cannot be named as beneficiary in Sections V VIII or IX. Title 10 U.S. Code Section 1448 requires that an otherwise eligible spouse concur if the member declines to elect SBP coverage elects less than maximum coverage or elects child only coverage. 28. INSURABLE INTEREST BENEFICIARY g. STATE h. ZIP CODE 29. Use this section to continue an item or make additional comments. Attach separate sheets if more space is needed. 30. MEMBER. Under penalties of perjury I certify that the number of withholding exemptions claimed does not exceed the number to which I am entitled and that all statements on this form are made with full knowledge of the penalties for making false statements 18 U.S. Code 287 and 1001 provide for a penalty of not more than 10 000 fine or 5 years in prison or both. Also I have been counseled that I can terminate SBP participation with my spouse s written concurrence within one year after the second anniversary of commencement of retired pay.