BENEFICIARY DESIGNATION FORM D Magazine D Magazine 401(k} Plan Plan Number: 878345 Request Type 7 initia! Designation TF Change to Designation Participant Information [Name (first, middle initial, last) [Bonel Secure Number | [ Married [] Single Beneficiary Information Subject tothe torms of my Employar's Plan, I request that any sum becoming due upon my death be payable tothe beneficiaries) ‘designated below. | understand this designation shall revoke all orior beneficiary designations made by me under my Employers Plan {All designations must be i whole percentages. Total percentage must equal 100% for Primary Beneficiary and 100% for Cansingant Beneficiary, i designated) Sanaa Nae (sane gana aE eterorsh DiPrivary Benehewy | Percentage Terese Social Security Number Date of Brak Tava [F Berets tame compatetogarnameraqareay | Reuonshg Cs Pawan Beveloany | Percentge Contingent Benetiiry Tareas Social Seniy Nambar Date of Bik TTT OT TBanatay War earns agar nae Taq Tetetonshe Ti Pima Benetoay | Pereonane Biconungent Bensiciay Tareas Sora Soeur Naber Die oT Sah Ta TBeretrery Waa Toamplee gal name Faq Teionei Primary Borehcary | Pareantege ‘contingent Beneiciay areas Saeial Seautiy Harber [Saar Sern TmnTaai | T Bavetcay Name Gonnate Ryu ame TaRUTeaT Taararane Ti Pray Benetoay | Porconage Ccontngent Benaiiny Tareas Social Seen Number [Da oF Ba marae [Fevers Nene tconpieteegelsameroqured) | Raauonsip SS Panay Genelia, Yreeraae— centage Coningem Benaiiny ‘arene Soo Seewiy amber Dave af Bik Fay) Unless otherwise requested: 1. If more than one beneficiary is designated, payment willbe made in equal shares tothe primary beneficiaries wha survive the Participant or annuitant or, i none survives te participant or annuitant, in agual shares to the contingent beneficiaries who survive tha panicipant or annuitant 2 fro beneficiary survives the panicipant or annuitant, payment will be made to tha axecutors or administrators of he estate ofthe particigant or annuitant 3. Ifa class ofbenaficiaries is designated (such as, “the children of the participant or annuitant’, than payment wil be made in equal shares to each person whois a member of the class and living at the death of the participant or annuitant whether or not ha/she has been specifically nama in the beneficiary designation. 4 Ifyou name an Estate ar Trust as beneficiary, contact your Plan Administrator for more information, Form No. 82094 ODK (10/04) Page 1 of (Incomplete without all pages)Beneficiary Designation Form (continued) D Magazine D Magazine 401(k} Plan Plan Number: 878345 ‘Name (first, middle intial, last) = ‘Security Number ication |/am not married atthe time | am making this beneficiary dasignation, | understand that later marry, | must submit a new designation naming my spousa as beneficiary, unless he ar she agrees in wnting ta diferent benefciy. |/am married and have named my spouse as sola/primary beneficiary. 5 1am married and have named someone other than my spouse as sole/primary beneficiary and my spouse agrees ta such designation (spouse must also sign below in the presence of a Notary Public or Plan Representative, Participant's Signature Signed in City/Town and State Date (mmiddiyyyy) Witness’ Name Witness’ Signature — Spousal Consent This is to certify that | am the spouse ofthe above named participant and agree withthe beneficiary designation | understand thatthe above designation specifies the only person(s) who will receive any death benefits payable inthe event of death of the participant [Spouse's Name Social Security Number ‘Spouse's Sianature Date Immiddiyyyy) SE State of _ County of, On this aay of z inthe year of before me, the undersigned officer, personally appeared a Tinown to me (or sausfactorly proven) ta ba the person ‘whose name is subscribed tothe within instrument and acknowledged that he/she executed forthe same purpose therein contained In Witness Whoreof, | hereunto set my hand Notary Publi Plan Rapresentative —<— — Please complete this form and return it to your Plan Admi Form No. 82094 ODK (10/04) Page 2 of 2 (Incomplete without all pages)