Model Qualified Domestic Relations Order

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REQUIREMENTS FOR A QUALIFIED DOMESTIC RELATIONS ORDER
1.
Must clearly identify the Plan name: United Food and Commercial Workers Union Local
655 Food Employers Joint Pension Plan.
2.
Must list the name, address, social security number and date of birth for the Plaintiff.
3.
Must list the name, address, social security number and date of birth for the Defendant.
4.
Must specify the amount payable to the Alternate Payee, either by specifying a dollar amount
or specifying a percentage of the participants benefit.
5.
Must specify how long payments are to be made to the Alternate Payee.
6.
Compliance - MUST clearly state that this Order does not require the Plan to provide any
type or form of benefit, or any option, not otherwise provided under the Plan Rules and
Regulations.
7.
Ms. Donna Frame, Administrative Manage for the Pension Fund, is the Plan’s agent for
service of legal process. Accordingly, if legal disputes involving the Plan arise, any legal
documents should be served upon Ms. Frame at the Pension Fund Office or upon any
individual Trustee. Ms. Frame’s direct line (636) 736-2712 or email address
.
8.
UFCW Local 655 Food Employers Joint Pension Plan
300 Weidman Road
Ballwin, MO 63011
Phone Number
(636) 736-2777 or (636) 394-6500
Fax Number
(636) 394-5006

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