Qualified Domestic Relations Order - Tennessee Consolidated Retirement System
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Tennessee Consolidated Retirement System
502 Deaderick Street
Nashville, Tennessee 37243-0201
(800) 922-7772
treasury.tn.gov/tcrs
_________________________ COURT
_________________________ COUNTY, TENNESSEE
CASE NO. ____________________
________________________________________ VS. ________________________________________
Plaintiff
Defendant
QUALIFIED DOMESTIC RELATIONS ORDER
This Order is intended to meet the requirements for a “quali ied domestic relations order” relating to
the Tennessee Consolidated Retirement System, hereinafter referred to as the “Retirement System”. This
Order relates to the provision of marital property rights and is an integral part of the divorce granted on
______________________.
(Month/Day/Year)
In compliance with those requirements, the following is speci ied:
1.
This order is intended to comply with and be administered and interpreted in accordance with
Tennessee Code Annotated, Section 8-36-128 and Chapter 1700-03-03 of the Of icial Rules and
Regulations.
2.
This Order assigns a portion of the bene its payable under the Retirement System to
_________________________________ in recognition of his/her marital rights in ________________________________’s
(Name of Alternate Payee)
(Name of Member)
bene its payable under the Retirement System.
3.
Member of the Retirement System is _____________________________, whose last known mailing address is
(Name of Member)
__________________________________________________________________________________________________________________
(Street Address)
__________________________________________________________________________________________________________________
(City)
(State)
(Zip Code)
- -
and whose Social Security Number is
OR
Alternate Veri ication Form is included.
TR-0466
Page 1
RDA-413
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