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EXHIBIT B
KEY EMPLOYEE PHANTOM STOCK AGREEMENT
Designation of Beneficiary(ies)
By virtue of my right under the Agreement to designate the beneficiary(ies)
of any death benefits payable under the Agreement, and subject to any future
exercise of said right by me, I hereby direct that any and all such death
benefits shall be paid, in accordance with the terms of the Agreement, to the
person(s) named below who are living at the time of each such payment, and,
unless otherwise expressly indicated, in equal shares among them if more
than one such person shall be living at the time of each such payment:
PRIMARY BENEFICIARY(IES)
________________________________________________________
Name/Relationship Address
________________________________________________________
Name/Relationship Address
________________________________________________________
Name/Relationship Address
In the event that no primary beneficiary shall be living at the time of any
death benefit payment, I hereby direct that such remaining payment(s) shall
be made to those person(s) named below who are living at the time of each
such remaining payment, and, unless otherwise expressly indicated, in equal
shares among them if more than one such person shall be living at the time of
each such remaining payment:
CONTINGENT BENEFICIARY(IES)
________________________________________________________
Name/Relationship Address
________________________________________________________
Name/Relationship Address
________________________________________________________
Name/Relationship Address
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Key Employee Phantom Stock Agreement
Designation of Beneficiary(ies)
Page Two
In the further event that none of the persons named above, either as primary
or contingent beneficiary(ies), shall be living at the time of any death
benefit payment, all remaining payment(s) shall be made to my estate pursuant
to the Agreement.
NOTE: If so specified in the above designations, "person" includes a
trust or corporation.
Employee: ______________________________
Signature Date
______________________________
Print Full Name
_______________________________
Witness
Receipt Acknowledged:
XXXX XXXXX XXXX XXXXXX, INCORPORATED
By:_________________________________
Date
