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

Model Qualified Domestic Relations Order Page 4

ACode@) , and Section 206(d)(3) of the Employee Retirement Income Security Act

of 1974, as amended (AERISA@), and the provisions hereof shall be administered

and interpreted in conformity with such Code and ERISA.

13.

The Court retains jurisdiction to amend this Order only for purposes of establishing

or maintaining its qualification as a Qualified Domestic Relations Order under the

code and ERISA.

14.

An attested copy of this Order shall be promptly delivered to the Plan Administrator,

Donna Frame, who shall within the time prescribed under Section 414(p)(6) of the

Internal Revenue Code notify the appropriate parties of the receipt of this Order, the

Plan’s procedure for review of its qualified status, and its determination as to

whether the Order is a Qualified Domestic Relations Order.

15.

All notices shall be mailed to the alternate payee at the mailing address stated in this

Order or to such other address as the alternate payee shall from time to time specify

by notifying the Plan Administrator in writing.

16.

The participant and the alternate payee shall each be responsible for the payment of

all taxes on the portion of benefits each receives under the laws that apply at the time

of distribution of benefits.

17.

The participant and alternate payee shall cooperate fully and execute any and all

documents necessary to obtain an amended Order, if necessary, meeting all

requirements of a Qualified Domestic Relations Order.

18.

The intend of 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.

Date this ____ day of _________________, _______.

BY THE COURT:

_________________________________

JUDGE

Approved as to form this

_______ day of _____________________, ______.

__________________________________

Attorney for Petitioner

Model Qualified Domestic Relations Order Page 4