Document:

Form of Restricted Stock Award Agreement

 EXHIBIT 10.41 
 THE TRIZETTO GROUP, INC. 
 1998 LONG-TERM INCENTIVE PLAN 
  

 Restricted Stock Award Agreement

 Performance Compensation Award 
  

 You are hereby awarded Restricted Stock subject to the terms and conditions set forth in this Restricted Stock Award
Agreement (the “Award”) and in The TriZetto Group, Inc. 1998 Long-Term Incentive Plan, as amended (the “Plan”), which is attached hereto as Exhibit A. All terms in this Award that begin with a capital letter are defined in
the Plan or in this Award. 
 By executing this Award, you agree to be bound by all of the Plan’s terms and conditions as if they had
been set out verbatim in this Award. In addition, you recognize and agree that all determinations, interpretations, or other actions respecting the Plan and this Award will be made by the Committee, and shall be final, conclusive and binding on all
parties, including you and your successors in interest. 
 Specific Terms. Your Performance Compensation Award has the following terms:

  

			
	Name of Participant	  	[                                      
                  ]
		
	Shares Subject to this Award	  	            shares of Common Stock of The TriZetto Group, Inc.
		
	Purchase Price per Share	  	$0.00
		
	Award Date	  	January 30, 2007
		
	Vesting	  	 This Award is a Performance Compensation Award, as defined in Section 10(b) of the Plan. The Shares subject to this Award will cliff vest on March
15, 2010 only if, and to the extent that, the Company achieves the financial performance specified in at least one of the “Performance Formulae” specified below:
  
 If the Company attains 24% compounded annual growth in the Performance Measure during the Performance
Period, 100% of the Shares subject to this Award shall vest on March 15, 2010.
  
 If the
Company attains 19.2% compounded annual growth in the Performance Measure during the Performance Period, 50% of the Shares subject to this Award shall vest on March 15, 2010.
  
 If the Company attains between 19.2% and 24% compounded annual growth in the Performance Measure
during the Performance Period, a proportional number of Shares subject to this Award shall vest on March 15, 2010.
  
 For purposes of this Award, the following definitions shall apply:
  
 •     The Performance Measure shall mean the Company’s earnings before

			
		  	 interest, taxes and other adjustments per share, and
  
 •     The Performance Period shall mean the three (3) year period commencing Jan. 1, 2007 and
ending Dec. 31, 2009.
  
 The Company’s fiscal year ending December 31, 2006
(excluding any impact of the legal settlement with McKesson Information Solutions LLC) shall serve as the base year for purposes of computing compounded annual growth in the Performance Measure during the Performance Period.
  
 Subject to the limits set forth in Section 10(b) of the Plan, for each fiscal year of the Company
that ends with or within the Performance Period, the Compensation Committee may, in its sole discretion, adjust the Performance Formulae.

		
	 Accelerated Vesting
	  	Your vesting under this Award will accelerate only under the circumstances expressly set forth in the Plan. See Section 13(b) of the Plan.
		
	 Deferral Election pursuant to Section 9 of the Plan
	  	  ̈   You are eligible to make this election if you desire to do so.
 x  You are not eligible to make this election.

 1. Dividends. Upon lapse of the vesting restrictions on this Award, you will receive an amount equal
to any cash dividends (plus simple interest at [            ] percent ([            ]%) per year), plus a number of
Shares equal to any stock dividends, which were declared and paid to the Company’s shareholders between the Award Date and the date such unrestricted Shares are issued to you. 
 2. Investment Purposes. You acknowledge that you are acquiring your Restricted Stock for investment purposes only and without any present intention of selling or distributing them. 
 3. Legend. Until all vesting restrictions lapse and new certificates are issued pursuant to the next section, certificates representing shares of
Restricted Stock issued pursuant to this Award shall bear the following legend: 
 The shares represented by this certificate are subject to
reacquisition under, and such shares may not be sold or otherwise transferred except pursuant to, the provisions of the Restricted Stock Award Agreement (Performance Compensation Award), dated [February 9, 2007], by and between The TriZetto Group,
Inc. and the registered owner of such shares. 
 4. Vesting Dates. As you satisfy vesting conditions of this Award, the Company shall cause new
certificates to be issued and delivered to you, free from the legend in the preceding section, but with any other legends the Company determines to be appropriate. New certificates shall not be delivered to you unless you have made arrangements
satisfactory to the Committee to satisfy tax-withholding obligations. If you do not satisfy the vesting requirements as of any vesting date, you will irrevocably forfeit any rights to those Shares subject to the vesting requirement on that date.

 5. Section 83(b) Election Notice. If you elect under Code Section 83(b) to be taxed immediately on your Restricted Stock when it
was granted to you, you promise to notify the Company of the election within 10 days of filing that election with the Internal Revenue Service. Exhibit B is a suggested form of Section 83(b) election. 
 6. Deferral Election. If allowed under the Specific Terms, at any time during the calendar year in which you receive this Award, you may irrevocably elect
to defer the receipt of all or a percentage of the Shares that 

  

 2 

 
would otherwise be issued to you on the lapsing of vesting restrictions of this Award in a future calendar year (or for the remainder of any calendar year in
which you make the election, provided the election occurs within the thirty (30)-day period after you first became an Eligible Person.) A copy of the form which you may use to make a deferral election is attached hereto as Exhibit C.
Notwithstanding the foregoing, Restricted Stock which has been subject to a Section 83(b) election is not eligible for deferral. 
 7. Not a
Contract of Employment. By executing this Award, you acknowledge and agree that (1) any person who is terminated before full vesting of an award, such as the one granted to you by this Award, could claim that he or she was terminated to
preclude vesting; (2) you promise never to make such a claim; (3) nothing in this Award or the Plan confers on you any right to continued Company employment or restricts the Company’s right to terminate your employment at any time for any or no
reason; and (4) the Company would not have granted this Award to you but for these acknowledgements and agreements. 
 8. Severability. Subject
to one exception, every provision of this Award and the Plan is intended to be severable, and any illegal or invalid term shall not affect the validity or legality of the remaining terms. The only exception is that this Award shall be unenforceable
if any provision of the preceding section is illegal, invalid, or unenforceable. 
 9. Notices. Any notice, payment or communication required
or permitted to be given by any provision of this Award shall be in writing and shall be delivered personally or sent by certified mail, return receipt requested, addressed as follows: (i) if to the Company, at the address set forth on the signature
page, to the attention of: General Counsel; (ii) if to you, at the address set forth below your signature on the signature page. Each party may, from time to time, by notice to the other party hereto, specify a new address for delivery of notices
relating to this Award. Any such notice shall be deemed to be given as of the date such notice is personally delivered or properly mailed. 
 10.
Binding Effect. Every provision of this Award shall be binding on and inure to the benefit of the parties’ respective heirs, legatees, legal representatives, successors, transferees, and assigns. 
 11. Headings. Headings shall be ignored in interpreting this Award. 
 12. Counterparts. This Award may be executed by the parties hereto in separate counterparts, each of which when so executed and delivered shall be an original, but all such counterparts shall together constitute the same
instrument. 
  

 3 

 BY YOUR SIGNATURE BELOW, along with the signature of the Company’s representative, you and the
Company agree that the Award is granted under and governed by the terms and conditions of this Award Agreement and the Plan. 
  

			
	THE TRIZETTO GROUP, INC.
		
	By:	 	  

	Name:	 	Jeffrey H. Margolis
	Title:	 	Chief Executive Officer
	Address:	 	c/o The TriZetto Group, Inc.
		 	567 San Nicolas Drive, Suite 360
		 	Newport Beach, California 92660

 The undersigned Participant hereby accepts the terms of this Award Agreement and the Plan.

  

			
	By:	 	  

	Name:	 	  

	Address:	 	  

  

 4 

 Exhibit A 
 THE TRIZETTO GROUP, INC. 
 1998 LONG-TERM INCENTIVE PLAN, AS AMENDED 

 Exhibit B 
 THE TRIZETTO GROUP, INC. 
 1998 LONG-TERM INCENTIVE PLAN 
 Section 83(b) Election Form 
 Attached is an Internal Revenue Code Section 83(b) Election Form. If you wish to make a Section 83(b) election, you must do so within 30 days of the date the restricted stock was transferred to you. In order to make the election,
you must completely fill out the attached form and file one copy with the Internal Revenue Service office where you file your tax return. In addition, one copy of the statement also must be submitted with your income tax return for the taxable year
in which you make this election. Finally, you also must submit a copy of the election form to the Company. A Section 83(b) election normally cannot be revoked. 

 THE TRIZETTO GROUP, INC. 
  

 Election to Include Value of
Restricted Stock in Gross Income 
 in Year of Transfer under Internal Revenue Code Section 83(b) 
  

 Pursuant to Section 83(b) of
the Internal Revenue Code, I hereby elect within 30 days of receiving the property described herein to be taxed immediately on its value specified in item 5 below. 
  

	1.	My General Information: 

  

			
	Name:	 	  

	Address:	 	  

		 	  

	SSN/TIN:	 	  

  
  
  

	2.	Description of the property with respect to which I am making this election: 

                      shares of
                     stock of The TriZetto Group, Inc. (“Restricted Stock”). 
  

	3.	The Restricted Stock was transferred to me on                  , 20__. This election
relates to the 20     calendar taxable year. 

  

	4.	The Restricted Stock is subject to the following restrictions: 

 The Restricted Stock is forfeitable until it is earned in accordance with The TriZetto Group, Inc. 1998 Long-term Incentive Plan (the “Plan”), Restricted Stock Award Agreement (the “Award”) or other Award or Plan
provisions. The Restricted Stock generally is not transferable until my interest becomes vested and non-forfeitable, pursuant to the Award and the Plan. 
  

	5.	Fair market value: 

 The fair market value at the time of
transfer (determined without regard to any restrictions other then restrictions which by their terms never will lapse) of the Restricted Stock with respect to which I am making this election is
$             per share. 
  

	6.	Amount paid for Restricted Stock: 

 The amount I paid for
the Restricted Stock is $             per share. 

	7.	Furnishing statement to employer: 

 A copy of this
statement has been furnished to my employer,
                                        .
If the transferor of the Restricted Stock is not my employer, that entity also has been furnished with a copy of this statement. 
  

	8.	Award or Plan not affected: 

 Nothing contained herein
shall be held to change any of the terms or conditions of the Award or the Plan. 
 Dated:
                         , 20    . 

	
	
	   
	 Taxpayer

 Exhibit C 
 THE TRIZETTO GROUP, INC. 
 1998 LONG-TERM INCENTIVE PLAN 
 Deferral Election Form 
 Attached is
the form you may use if you wish to defer the receipt of all or a percentage of the Shares that would otherwise be issued to you upon the lapse of the vesting restrictions on your Award. You must submit a copy of the Deferral Election Form executed
by you to the Company as provided for in the form. An election to defer receipt of your Shares may not be revoked. 
 You are advised to
consult with your individual tax advisor with respect to the tax consequences related to your Award and any elections you may make to defer the receipt of shares. 

 THE TRIZETTO GROUP, INC. 
 1998 LONG-TERM INCENTIVE PLAN 
  

 Deferral Election Form 
  

 Pursuant to Section 6 of the Restricted Share Award granted to me on
            , 20     (the “Award Date”), I hereby irrevocably elect to defer the receipt of
        % of the shares of common stock of the Company that would otherwise be issued to me in a future calendar year upon the lapsing of transfer restrictions of the Award granted to me under the Plan
on the Award Date. All terms that begin with a capital letter are defined in the Plan or in the Award. 
 I understand and acknowledge that
this election is irrevocable. 
 I understand and acknowledge that this election will be ineffective if it is made in a calendar year
other than the one in which the Award Date occurred, unless I have just become an Eligible Person. If I have just become an Eligible Person, I understand that this election will be ineffective with respect to the remainder of this calendar year if
my election is made after the thirtieth day on which I first became an Eligible Person. 
  

			
	Witnessed by:	    	PARTICIPANTForm of Deferred Compensation Agreement

 EXHIBIT 10.11 
 The following officers have executed Deferred Compensation Agreements, a form of which follows, with Carmike Cinemas, Inc. as of the dates indicated below: 
  

			
	 Officer
	  	 Date Executed

		
	Michael W. Patrick	  	April 16, 1990
		
	Richard B. Hare	  	August 18, 2006
		
	Martin A. Durant	  	July 16, 1999
		
	Fred W. VanNoy	  	April 16, 1990
		
	Anthony J. Rhead	  	April 16, 1990
		
	Lee Champion	  	June 30, 1998
		
	H. Madison Shirley	  	April 16, 1990

 DEFERRED COMPENSATION AGREEMENT 
 This Agreement, made and entered as of the ______ day of _______, by and between CARMIKE CINEMAS, INC., a Delaware corporation with its principal office
in Columbus, Georgia (the “Employer”), and ______________, a resident of ______________, (the “Employee”). 
 WITNESSETH:

 WHEREAS, Employee is a valued executive employee of Employer; and 
 WHEREAS, Employer wishes to aid Employee in providing for his retirement and to provide benefits upon Employee’s death or disability; and

 WHEREAS, Employer will provide these benefits to Employee in accordance with the terms and provisions of this Deferred Compensation
Agreement (the “Agreement”) and a related trust to be contemporaneously established (the “Trust”) the terms of which are hereinafter described; and 
 WHEREAS, it is intended that this Agreement and related Trust shall qualify as a “top hat” plan for key employees; and 

 WHEREAS, it is intended that payments by Employer under this Agreement to the Trust shall, for federal
and state income tax purposes, be included in Employee’s income and deducted by Employer in the year paid. 
 NOW, THEREFORE, in
consideration of the mutual promises and obligations contained herein, the parties hereto agree as follows: 
 I. DEFERRED COMPENSATION.

 (a) Contributions. Upon the execution of this Agreement and the Trust, Employer shall pay _________ DOLLARS
($ __________ ) to the Trust for the use and benefit of Employee, as more specifically described in the Trust. In addition, for the calendar quarter beginning _______________, and within forty-five (45) days following the end of each
succeeding calendar quarter during which Employee shall be employed by Employer for the entire calendar quarter, but subject to termination as described in paragraph (b) of this Article I or Article IV, Employer shall make payments equal to ten
percent (10%) of Employee’s taxable compensation for such calendar quarter (as same shall be reflected by Employer for the calendar year on Employee’s Form W-2 or Form 1099), in the following manner: 
 (1) If Employee is eligible to make a tax deductible contribution to an Individual Retirement Account (“IRA”) for a calendar
year as provided for in section 408 of the Internal Revenue Code of 1986, as amended (the “Code”), Employer shall, on or before April 15 of the next calendar year, pay directly to an IRA established for the benefit of Employee an
amount equal to the maximum amount deductible by Employee for federal income tax purposes as a contribution to an IRA for such calendar year; 
 (2) Employer shall withhold an amount, as determined by Employer in its best judgment, which represents the appropriate amount of federal and state income taxes to be withheld on the amount of deferred compensation
paid hereunder; and (3) The remaining amount of deferred compensation, after deducting the amounts described in (1) and (2) above, shall be paid within forty-five (45) days after the end of each calendar quarter, to the Trustee
of the Trust established by Employee, the general terms of which are described in Article II. 

 (b) Termination of Contributions. Notwithstanding that Employee may continue to be
employed by Employer and any other provision of this Agreement to the contrary, payments by Employer equal to ten percent (10%) of Employee’s taxable compensation, as hereinabove described in paragraph (a) of this Article I, shall
cease as of the end of the calendar quarter immediately prior to the first date that benefits become distributable from the Trust. 
 II.
SUMMARY OF TRUST PROVISIONS. 
 The Trust created by Employer shall be an irrevocable trust established by Employer solely for the benefit of
Employee. All expenses of maintaining the Trust shall be borne either by the Trust or by Employer. The Trustee of the Trust shall receive from Employer the amount hereinabove provided for under Article I, and shall hold, manage, invest and
administer the funds received and the income earned thereon according to the terms and conditions contained in the Trust. With respect to the management, investment and administration of the Trust, and subject to the terms and definitions therein,
the Trust shall provide the following: 
 (a) Trust Income. All Trust income shall be accumulated and added to principal.

 (b) Employee Treated as Owner. Employee, as beneficiary of the Trust, shall be treated as the “owner” of the
Trust as that term is used in section 671 of the Code, and the Trust shall be a “grantor trust” for Federal income tax purposes with the taxable income earned by the Trust being taxed to Employee. 
 (c) Irrevocable Trust. The Trust shall be irrevocable and the Trust assets, whether income or principal, shall not be subject to the
claims of creditors of Employer, Employee or any beneficiary of the Trust. 
 (d) Anti-alienation. No right, benefit, or
payment under the Trust shall be subject to sale, anticipation, alienation or assignment by Employee or his beneficiaries. 

 (e) No Continued Employment Rights. Employee shall have no right to continued employment
with Employer on account of this Agreement or Employee’s status as a beneficiary of the Trust. 
 (f) Events of
Distribution. Unless Employee elects in writing an earlier commencement date for the payment of benefits from the Trust at any time after Employee attains age 60, Employee, or his beneficiaries, shall have no right or claim to any benefits from the
Trust until Employee attains age 70, becomes totally disabled or dies. Upon the happening of any such distribution event, Employee or Employee’s beneficiary, as the case may be, shall be entitled to receive payments from the Trust, as described
in paragraph (g) of this Article. 
 (g) Payment of Benefits. Except as may be modified by the joint and survivor annuity
provisions, the Trust shall provide that upon Employee’s attainment of age 70, or upon his earlier death or total disability, or upon Employee’s election to commence the payment of benefits after attaining age 60, payments from the Trust
to Employee or his beneficiary shall be made, commencing within sixty (60) days after any such event, as follows: 
 (1)
One-half (1/2) of the benefits shall be paid in the form of a life annuity with payments guaranteed for five (5) years should Employee not live to receive the annuity payments for at least five (5) years, with any unpaid guaranteed
portion being paid to Employee’s designated beneficiary; and 
 (2) The remaining one-half (1/2) of the benefits
shall be paid either as an annuity or in a lump sum payment, as designated in writing by Employee. 
 In accordance with ERISA
Section 206 (a), Employee hereby elects that the payment of benefits under the Trust shall commence at such time as hereinabove provided for in this paragraph (g) and in Article V of the Trust, and not as set forth in ERISA
Section 206 (a). 

 (h) Designation of Method of Payment. Except as may be modified by the joint and survivor
annuity provisions, Employee shall designate the method of payment of one-half (1/2) of the benefits from the Trust, as hereinabove described in paragraph (g)(2), by executing a “Designation of Method of Benefit Payment” form and
delivering it to the Trustee. At any time prior to the commencement of the payment of benefits as provided for under paragraph (h), the “Designation of Method of Benefit Payment” form may be modified, altered, or revoked as to any benefits
payable under paragraph (g) (2) of the Trust. If Employee fails to execute a “Designation of Method of Benefit Payment” form and deliver it to the Trustee, the Trustee shall pay over and distribute such one-half
(1/2) portion of the Trust in one lump-sum to Employee or his beneficiary, as the case may be. 
 The Trust shall provide that upon
making any distribution to Employee, the Trustee shall withhold from such distribution the amount, if any, required to be withheld for federal, state and local taxes. 
 (i) Joint and Survivor Annuity Requirements. 
 (1) Qualified Joint and Survivor Annuity. Unless an optional form of benefit is selected pursuant to a qualified election within the 90-day period ending on the annuity starting date, the benefits of Employee, if
Employee is married, will be paid in the form of a qualified joint and survivor annuity, and if Employee is not married, Employee’s benefits will be paid in the form of a life annuity. 
 (2) Qualified Preretirement Survivor Annuity. If Employee dies before the annuity starting date and has not selected an optional form of
benefit within the election period pursuant to a qualified election, then Employee’s full benefit under the Trust shall be applied toward the purchase of an annuity for the life of the surviving spouse. The surviving spouse may elect to have
such annuity distributed within a reasonable period after Employee’s death. 
 (j) Designation of Beneficiary.

 (1) Manner of Designation. In the event Employee dies before receipt of all of his benefits under the Trust,
Employee’s beneficiary shall be 

 
his spouse; provided, however, Employee may, from time to time, designate a beneficiary other than his spouse if Employee’s spouse consents irrevocably,
in writing, to such designation of Employee’s beneficiary; acknowledges the effect of such election; and such consent and acknowledgment and the spouse’s signature is witnessed by a Notary Public. Each beneficiary designation shall be on a
form furnished by the Trustee and will be effective only when filed with the Trustee during Employee’s lifetime. Each beneficiary designation filed by Employee with the Trustee will revoke all such designations previously filed by him and such
revocation shall not require the consent of any previously designated beneficiary. Any beneficiary designation previously made by Employee shall automatically be revoked upon the marriage or remarriage of Employee. A spouse’s consent shall be
valid only with respect to the specified beneficiary or beneficiaries by Employee unless the spouse has consented to expressly permit designations by Employee without the spouse’s further consent. The spouse’s consent to any beneficiary
designation made by Employee, once made, may not be revoked by the spouse. Notwithstanding the foregoing, spousal consent to Employee’s beneficiary designation shall not be required if: (i) the spouse is designated as the sole primary
beneficiary by Employee, or (ii) it is established to the satisfaction of the Trustee that spousal consent cannot be obtained because there is no spouse, because the spouse cannot be located or because of such other circumstances as may be
prescribed in Regulations issued by the Secretary of the Treasury. Any consent by a spouse or any determination that the consent is not required above shall be effective only with respect to such spouse. 
 (2) Failure to Designate Beneficiary. If Employee fails to designate a beneficiary, or if the designated beneficiary dies before Employee
or before distribution of all of the benefits and there are no alternate designated beneficiaries, the Trustee shall distribute such benefits to the following persons in the following order of priority: 
 (i) The spouse of Employee, if then living, and if not, 
 (ii) The estate of the last to die of Employee or any designated beneficiary of Employee. 

 III. RESTRICTIONS. 
 No right or benefit under this Agreement or the Trust shall be subject to anticipation, alienation, sale, assignment, pledge, encumbrance or charge, and any attempt to anticipate, alienate, sell, assign, pledge,
encumber or charge the same shall be void. No right or benefit under this Agreement or the Trust shall in any manner be subject to the debts, contracts, liabilities or torts of the person entitled to such benefits. If Employee or a beneficiary of
Employee hereunder should become bankrupt or attempt to anticipate, alienate, sell, assign, pledge, encumber or charge any right to a benefit under this Agreement or the Trust then any benefits, provided for in this Agreement or the Trust, shall
cease. Employer or Trustee shall, in the discretion of Employer or Trustee, as applicable, hold or apply such benefit or any part thereof on behalf of Employee or the beneficiary or beneficiaries of Employee, in such manner as Employer or Trustee
may deem proper. 
 IV. TERMINATION OF AGREEMENT. 
 Except for the final payment by Employer for the calendar quarter immediately preceding the calendar quarter during which Employee shall terminate his employment with Employer or, if earlier, upon the first date that
benefits become distributable from the Trust, Employer’s obligations under this Agreement and the compensation provided for hereunder shall automatically cease upon such event. This Agreement does not create a guaranteed term of employment, and
Employer may terminate Employee’s employment at any time and with or without cause. 
 V. MISCELLANEOUS. 
 (a) The captions or headings in this Agreement are made for convenience and general reference only and shall not be construed to describe,
define or limit the scope or intent of the provisions of this Agreement. 
 (b) Any reference hereunder to the Employer shall
expressly be deemed to include the Employer’s successor and assigns. 

 IN WITNESS WHEREOF, Employer has caused this Agreement to be duly executed by and through its duly
authorized corporate officers, with its corporate seal to be hereunto affixed, and Employee has hereunto set his hand and seal as of the day and year first above written. 
  

			
	EMPLOYER:
	
	CARMIKE CINEMAS, INC.
		
	BY:	 	  
		
	Its:	 	  
		
	ATTEST:	 	  
		
	Its:	 	  
	
	(Corporate Seal)
	
	EMPLOYEE:

					
			
		 	  	 	(L.S.)

 DESIGNATION OF METHOD OF BENEFIT PAYMENT 
 I, ____________, hereby elect on behalf of myself, and my beneficiary or beneficiaries, to receive one-half (1) of the benefits from that Trust
Agreement entered into as of the ______ day of ___________, by and between Carmike Cinemas, Inc., as Grantor, and ________________, ______________________ and ________________, as Trustees, in the following form: 
 (a) One (1) lump sum payment. 
 (b) A
life annuity described as follows: 
 [Please strike one of the above two options.] 
 Executed this _______________ day of ______________. 
  

 SPOUSE’S CONSENT 
 I hereby consent to the designation made by my spouse to have all benefits under the Trust payable to ___________________ 
                                       
                                        
                                        
                                        
                                        
                                        
                    
 Beneficiary(ies) as specified on my
spouse’s Designation form dated __________________________________________________. The benefits have been explained to me, and I hereby acknowledge that I understand (1) that the effect of such designation is to cause my spouse’s
benefits to be paid to a Beneficiary other than me; (2) that such Beneficiary Designation is not valid unless I consent to it; and (3) that my consent is irrevocable unless my spouse revokes the Beneficiary Designation. 
  

					
			
	  	 		 	  
	Date        	 		 	Spouse’s Signature

 STATE OF GEORGIA 
 COUNTY OF
MUSCOGEE 
 BEFORE ME, the undersigned authority, a Notary Public in and for said County and State, on this day personally appeared,
______________________________________________________________________________, known to me to be the person whose name is subscribed to the foregoing instrument, and I hereby acknowledge that said person has signed said Consent as a free and
voluntary act for the uses and purposes therein set forth. 
 GIVEN UNDER MY HAND AND SEAL this ____________________ day of
__________________________, ______. 
  

 Notary Public 
 My Commission Expires: 
             ________________

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00119-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00119-of-00352.parquet"}]]