Article Guide
The CO-1049A form, also known as the Limited Durable Power of Attorney (LDPOA) for post-retirement, is a crucial document designed for members of the Connecticut State Employees Retirement System (SERS). This form allows individuals to designate an Attorney-In-Fact who will act on their behalf for specific retirement-related transactions. By utilizing this form, retirees can ensure that their financial matters, such as changing addresses, tax withholding, and updating beneficiary information, are managed smoothly, even in the event of incapacity. It is essential to understand that this LDPOA is limited in scope and does not permit changes to payment elections or survivor annuitants after retirement. The CO-1049A must be completed thoroughly, signed, dated, and properly witnessed and notarized to be valid. Strict adherence to the guidelines set forth in the form is recommended to safeguard individual interests, and seeking legal counsel is advised before signing. It is also pertinent to note that if the designated Attorney-In-Fact is a spouse, the form may automatically be revoked in the instance of divorce, unless explicitly stated otherwise. As a matter of courtesy, the Retirement Services Division reviews all submissions of this form to ensure compliance and protect the rights of retired members.
Form Sample
Power of Attorney - Post Retirement |
STATE OF CONNECTICUT |
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State Employees Retirement System |
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OFFICE OF THE STATE COMPTROLLER |
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RETIREMENT SERVICES DIVISION |
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Page 1 of 2 |
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LIMITED DURABLE POWER OF ATTORNEY (LDPOA) - POST RETIREMENT
PART I - GENERAL INFORMATION AND INSTRUCTIONS - PLEASE READ CAREFULLY
Connecticut statutes allow an entity to establish its own criteria as to what it will accept with regard to a Limited Durable Power of Attorney (LDPOA). In order to safeguard the interests of members of the State Employees' Retirement System (SERS) a member wishing to designate someone as his or her
1. This LDPOA gives the person you designate the power to make any and all decisions for your SERS related matters on your behalf. The RSD is providing this instrument to its SERS members as a matter of courtesy. Due to the significance of this document RSD strongly recommends that you seek legal advice before signing this document.
2. This LDPOA remains in effect until the earliest of the following occurs: (a) your death; (b) your
3. If your
4. This LDPOA will continue in full force and effect despite any incapacity or disability you may suffer after execution.
5. This LDPOA is limited to certain post retirement transactions such as changing an address or tax withholding.
In accordance with the provisions of the State Employees Retirement Act, payment election options and survivor annuitants cannot be changed for any reason after retirement.
PART II - MEMBERS (PRINCIPAL) INFORMATION (Type or Clearly Print This Information)
MEMBER'S NAME (Last)
First Name
M.I.
EMPLOYEE NO.
SOC SEC NO.
MEMBER'S ADDRESS (Street, No., Name) (City, State, Zip Code)
PART III - DESIGNATION OF ATTORNEY-
The individual you wish to designate as your
NAME (Last, First, M.I.)
First Name
M.I. |
SOC SEC NO. |
ADDRESS (Street, No., Name) (City, State, Zip Code) |
RELATIONSHIP |
PART IV - AGREEMENT AND ACKNOWLEDGEMENT
I have read or have had explained to me the information contained on this page, page one of this two page LDPOA form, and I understand its contents. I understand that I am also referred to as the Principal in and throughout this document.
Name of Member (Principal) |
Date |
Directions: As you have retired: Fill in and execute both pages of this LDPOA form. Keep a copy for your records and send the original LDPOA (both pages) directly to the Retirement Services Division, Payroll Unit, 55 Elm Street, Hartford, CT 06106. Please note that payment election options and survivor (contingent) annuitants cannot be changed for any reason after retirement.
Power of Attorney - |
STATE OF CONNECTICUT |
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OFFICE OF THE STATE COMPTROLLER |
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State Employees Retirement System |
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RETIREMENT SERVICES DIVISION |
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LIMITED DURABLE POWER OF ATTORNEY (LDPOA) - POST RETIREMENT |
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I hereby give |
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(name of |
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on the first page of this two page form, the full power and authority to represent me in the following post retirement plan transactions on my behalf with SERS to the extent that I could do myself as a member of SERS. My
Responding to SERS request for information or documents or representing me in any request for information or forms.
Designate a beneficiary to receive remaining contributions and interest (if any) after my death and the death of any contingent annuitant.
Changing my tax withholding.
Changing the address or bank to which my SERS payments are sent: however SERS will not make the check payable to my
Important Note For Direct Deposit & Direct Deposit Changes Only: A power of attorney may not be necessary to make changes to direct deposits. For direct deposit and direct deposit changes only, RSD will accept a copy of the Representative Payee designation made by the Commissioner of Social Security. There are two such types of payees: an individual representative payee who could be a family member or friend or a lawyer, a legal guardian, or a volunteer for a government or
By signing this form. I am granting(name of
authority to act on my behalf with regard to the SERS transactions I have marked above. I understand the legal impact in executing this LDPOA and hereby agree to hold SERS, the State of Connecticut and its employees harmless for any alleged misuse, mismanagement or malfeasance by the
IN WITNESS WHEREOF, I have signed this Limited Durable Power of Attorney on |
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Signature of Member (Principal) |
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Address (Street/Town/State) Where Signed |
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Statement of Witnesses: I declare that the Principal has identified himself or herself to me, that the Principal signed or acknowledged this LDPOA in my presence, that I believe the Principal to be of sound mind, that the Principal has affirmed that the Principal is aware of the nature of the document and is signing it voluntarily and free from duress.
1. Witness Signature: |
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2. Witness Signature: |
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Date signed: |
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Date signed: |
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Address: |
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Address: |
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Acknowledgement: On this day before me, a Notary Public or Commissioner of the Superior Court, authorized to administer
oaths in the State that the Member resides, personally appeared |
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(Member/Principal) who is personally |
known to me or proved to me on the basis of satisfactory evidence |
to be the person whose name is subscribed as the Principal |
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within this instrument, executed this document in my presence, and personally acknowledged to me that he/she executed this LDPOA for the purposes herein stated.
Signed and sworn before me this |
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day of |
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Signature of Notary Public or Commissioner of the Superior Court: |
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State: |
Town: |
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My commission expires |
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SEAL HERE |
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Document Specifications
| Fact Name | Details |
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| Purpose | The CO-1049A form creates a Limited Durable Power of Attorney (LDPOA), allowing a designated person to act on behalf of a retiree for specific transactions related to the State Employees Retirement System (SERS). |
| Governing Law | This form operates under the provisions of the State Employees Retirement Act in the State of Connecticut. |
| Effectiveness | The LDPOA remains effective until the retiree's death, revocation of the document, or divorce if the Attorney-In-Fact is a spouse. |
| Power Limitations | The form allows for post-retirement transactions such as changing an address or tax withholding but does not permit changes to payment elections or survivor annuitants. |
| Legal Advice Recommendation | The Retirement Services Division recommends that individuals seek legal advice before signing the CO-1049A due to its significance and implications. |
Steps to Filling Out Co 1049A
After gathering all necessary information, the process of completing the CO-1049A form involves several careful steps. This form must be filled out accurately, signed, and executed with witnesses and notarization as required. It is important to retain a copy for your records once the form has been submitted.
- Begin by filling in your basic information in Part II. Include your name, employee number, social security number, and address.
- Proceed to Part III, where you will designate your Attorney-In-Fact. Provide their name, social security number, address, and relationship to you.
- In Part IV, read the agreement and acknowledgment section carefully. Confirm that you understand the contents of the form.
- Sign and date the document in the designated space to affirm your intent.
- Next, you will need to have two witnesses sign the form. Each witness should also provide their address and the date signed.
- Finally, take the completed form to a Notary Public or Commissioner of the Superior Court. They will acknowledge your signature and complete their part by signing and dating the form.
- Ensure you keep a copy of the signed LDPOA form for your records.
- Submit the original document (both pages) to the Retirement Services Division at 55 Elm Street, Hartford, CT 06106.
More About Co 1049A
What is the CO-1049A form?
The CO-1049A form is the Limited Durable Power of Attorney (LDPOA) specifically for members of the State Employees Retirement System (SERS) in Connecticut. This form allows you to designate someone to represent you in matters related to your retirement benefits. It’s a crucial document that enables your Attorney-In-Fact to handle specific transactions on your behalf.
Who can be designated as my Attorney-In-Fact?
You can choose any individual to act as your Attorney-In-Fact, as long as they are capable of fulfilling the responsibilities. This may include a family member, friend, or trusted advisor. Keep in mind that it's essential to select someone you trust, since they will have significant authority over your retirement transactions.
How long does the power of attorney last?
The LDPOA remains in effect until one of several events occurs. This includes your death, if you revoke the power in writing, or if your Attorney-In-Fact chooses to relinquish their duties. Notably, if your Attorney-In-Fact is your spouse and you file for divorce, the power will be presumed revoked unless otherwise noted.
What transactions can my Attorney-In-Fact handle?
Your Attorney-In-Fact can manage various post-retirement transactions, such as changing your address, modifying tax withholding, and representing you in communication with SERS. However, some aspects, like changing payment elections and survivor annuitants, cannot be changed after you retire.
Do I need legal advice before signing this form?
Common mistakes
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Not reading the instructions carefully before filling out the form.
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Forgetting to sign and date both pages of the LDPOA.
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Failing to have the signatures witnessed as required.
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Not getting the document notarized, which is essential for validation.
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Providing incomplete or incorrect personal information, such as names or addresses.
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Designating someone as Attorney-In-Fact without confirming their willingness to take on the role.
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Not understanding that the LDPOA can't be amended once it's signed.
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Overlooking the impact of divorce on the LDPOA if the Attorney-In-Fact is a spouse.
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Misunderstanding the limitations of the LDPOA regarding post-retirement transactions.
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Not keeping a copy of the completed form for personal records.
Documents used along the form
When using the CO-1049A form, there are several other forms and documents that may also be necessary to facilitate transactions related to your post-retirement benefits. Below is a list of commonly used documents that often accompany the CO-1049A.
- CO-1049B - Notice of Revocation: This form is used to revoke the Limited Durable Power of Attorney. It must be submitted to the Retirement Services Division to ensure that all parties are notified of the revocation.
- CO-1049C - Beneficiary Designation Form: This document allows you to designate beneficiaries for your retirement benefits. It is essential when determining who will inherit your remaining contributions and interest after your passing.
- CO-1049D - Direct Deposit Enrollment Form: This form is needed to set up or change direct deposit information for your retirement payments. It’s crucial for ensuring that your benefits are deposited into the correct bank account.
- CO-1049E - Tax Withholding Form: Use this form to select or change your tax withholding options. Proper completion ensures that your retirement benefits are taxed appropriately.
- Affidavit of Authority: This document serves as proof that the person you designated as your Attorney-In-Fact has the authority to act on your behalf. It can be particularly helpful in clarifying responsibilities.
- Health Care Proxy: While not directly related to retirement benefits, this document allows you to designate someone to make health care decisions for you if you become unable to do so. It’s important for your overall planning.
These documents work together to streamline the management of your retirement benefits and ensure that your wishes are executed correctly. Make sure to keep copies for your records and consult with a professional if you have any questions about which forms you need.
Similar forms
The first document similar to the Co-1049A form is a General Power of Attorney (GPOA). Just like the Co-1049A, a GPOA allows one individual to authorize another to make decisions and take actions on their behalf. However, while the Co-1049A is specifically tailored to manage post-retirement dealings with the Connecticut State Employees Retirement System, a GPOA can be broader in scope. This means it can give the Attorney-in-Fact authority over various financial and legal matters, such as selling property or handling bank transactions, not just limited to retirement accounts. Both forms require signatures, but the GPOA can be more flexible in how it is structured and utilized.
An Advance Healthcare Directive is another similar document. This directive allows an individual to specify their healthcare preferences and appoint someone to make medical decisions if they become unable to do so themselves. While the Co-1049A focuses on financial and administrative choices related to retirement, the healthcare directive is concerned with medical decisions. Both documents empower an individual to choose a representative to act in their interest, whether in financial or healthcare matters. They are essential tools for ensuring that one’s wishes are honored in crucial situations.
A Durable Power of Attorney (DPOA) is also akin to the Co-1049A form. Similar in function, it grants authority to a designated person to act on behalf of the principal in various financial matters. Like the Co-1049A, the DPOA can endure even if the principal becomes incapacitated. However, the DPOA is not limited to post-retirement activities and can cover a wide array of transactions. This flexibility can make it preferable for some individuals, especially those who seek comprehensive management of their affairs rather than one narrow area such as retirement benefits.
Another related document is the Representative Payee designation. This document specifically applies to Social Security benefits, allowing an appointed person to manage payments on behalf of someone who is unable to handle their finances. The Co-1049A shares this concept but applies it uniquely to retirement-related transactions. Both documents aim to protect the interests of individuals who might not be able to manage their own affairs, ensuring continuity in their financial transactions. This slightly different focus means that while they share purposes, they cater to different needs and sources of income.
An Authorization for Release of Information form can also be seen as similar. This form allows individuals to designate someone to obtain personal information, such as medical records or financial information, from various entities. Like the Co-1049A, it serves to empower another individual to act on one's behalf, particularly within a specific domain. However, the Authorization for Release of Information is typically less formal regarding financial control and focuses more on the sharing of information necessary for effective management, particularly in healthcare and insurance matters.
Lastly, a Living Will complements the Co-1049A by addressing decisions regarding end-of-life care. While the Co-1049A authorizes actions to be taken regarding retirement benefits, a Living Will defines an individual's preferences for medical treatment if they are unable to communicate their wishes. Both of these documents reflect an individual's right to pre-determine how their affairs should be handled, whether that involves financial transactions or critical healthcare decisions. While they focus on different aspects of personal care and management, they collectively emphasize the importance of having one’s wishes clearly stated and respected.
Dos and Don'ts
When filling out the CO-1049A form, there are important steps to consider. Here’s a list of things you should and shouldn’t do to ensure that your application is processed smoothly.
- Do read all instructions carefully before beginning. Understanding the requirements will simplify the process.
- Do ensure all information is clearly printed or typed. Illegible writing can lead to delays.
- Do have the form signed, dated, witnessed, and notarized as required. Missing signatures can invalidate the document.
- Do keep a copy of the completed form for your records. It’s essential to have your own reference.
- Do consult with a legal professional if you have questions about the powers granted in the form. It is wise to seek advice when needed.
- Don’t forget to consider the implications of granting a power of attorney. Understand the responsibilities it entails for your Attorney-In-Fact.
- Don’t leave any sections incomplete or unanswered. Incomplete forms may be returned for corrections.
- Don’t assume that changes can be made to your payment election options after retirement. This cannot be altered.
- Don’t overlook the need for witness signatures and notarization. Each step must be followed to ensure validity.
By following these guidelines, you can facilitate a successful submission of your CO-1049A form and ensure that your power of attorney is established correctly. This will help protect your interests regarding your retirement benefits.
Misconceptions
Understanding the CO-1049A form, also known as the Limited Durable Power of Attorney for Post Retirement, can help eliminate confusion. Here are some common misconceptions regarding this important document:
- This form gives unlimited powers to my Attorney-In-Fact. While it does grant authority concerning SERS transactions, it is limited specifically to certain post-retirement matters.
- The CO-1049A form is permanent. This is not the case. The power of attorney remains valid until your death, revocation, or other specific conditions apply, such as divorce.
- I can use this form to change my payment elections or survivor annuitants. Unfortunately, once you retire, changes to payment elections or survivor annuitants cannot be made for any reason.
- My Attorney-In-Fact can handle financial matters outside of SERS. This form is exclusively for SERS-related transactions, so your Attorney-In-Fact's power does not extend beyond those specific tasks.
- User-generated amendments to the form are allowed. The CO-1049A cannot be amended. It is crucial to use the standard form for any power of attorney designations.
- Signing this form is straightforward with no need for additional advice. Given the significance of this document, it’s strongly recommended to seek legal advice before committing to it.
- If my Attorney-In-Fact is my spouse, I can assume the power remains intact through a divorce. In fact, the form is automatically revoked unless explicitly stated otherwise during divorce proceedings.
- A notary is not required for this form to be valid. A witness and a notary are crucial for the proper execution of the CO-1049A form. Both must be present at signing for validation.
Getting the facts right can safeguard your interests when navigating your retirement transactions. Familiarize yourself with the specifics of the CO-1049A to ensure compliance and a smoother process.
Key takeaways
- This form is designated for members of the State Employees Retirement System (SERS) in Connecticut.
- Completing the CO-1049A allows you to appoint an Attorney-In-Fact for post-retirement transactions.
- It is essential to read the instructions carefully before filling out the form.
- The document must be signed, dated, witnessed, and notarized appropriately.
- The power granted to your Attorney-In-Fact encompasses decisions regarding SERS matters only.
- Once signed, this power of attorney remains effective until you pass away, revoke it, or if your Attorney-In-Fact resigns.
- If the Attorney-In-Fact is your spouse, the power of attorney will be automatically revoked if either of you files for divorce.
- Changes to essential elements, such as payment election options, cannot be made once you are retired.
- The form includes provisions for tasks like changing tax withholding or updating your address with SERS.
- It is recommended to seek legal advice prior to executing the document due to its significance.