Colorado § 15-22-106 - Statutory form of a designated beneficiary agreement.

§ 15-22-106. Statutory form of a designated beneficiary agreement.

(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estate planning documents and will be superseded and set aside to the extent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designated beneficiary agreement is superseded by such other documents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;

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;

The right to

have standing to

sue for

wrongful death

in the event of

my death; and

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

________________________

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.

Cross references: For provisions relating to the time of taking effect or the provisions for transition of this code, see § 15-17-101.