Model Qualified Domestic Relations Order (Page 2 of 4) in pdf

Model Qualified Domestic Relations Order Page 2

STATE OF ______________________)

COUNTY OF ____________________)

THE CIRCUIT COURT OF _______________

IN RE: THE MARRIAGE OF:

)

Petitioner,

)

and

)

Respondent.

)

MODEL QUALIFIED DOMESTIC RELATIONS ORDER

WHEREAS, by order issued __________ {date of Order}, the marriage of ______________

{participant} and __________________ {alternate payee} has been dissolved: and

WHEREAS, in connection with the property settlement executed relative to the distribution

of property between _____________{participant} and ____________{alternate payee}, certain

retirement benefits earned by ____________ {participant} are to be transferred to {alternate payee}.

IT IS HEREBY ORDERED:

The alternate payee is assigned a benefit equal to ___percent of the actuarial present

value of the participant’s accrued benefit as of ___________, the date the Dissolution

of Marriage was entered, earned under the Plan during the Period beginning

____________ {date of marriage} and ending ___________ {date of Dissolution of

Marriage} to be paid in the form of a single life annuity with no survivor benefit, for

the life of the alternate payee [participant], at the alternate payee’s election as early

as the participant’s earliest retirement age under the plan.

Prior to the commencement of benefits to the alternate payee, the alternate payee is

to be treated as the surviving spouse for purposes of the qualified pre-retirement

survivor annuity with regard to ___percent of the participant’s accrued benefit

earned under the Plan during the period beginning _______ {date of marriage} and

ending __________, the date the Dissolution of Marriage was entered.

Model Qualified Domestic Relations Order Page 2