Teachers' Retirment System Confidential Information/qdro
ADVERTISEMENT
1TEACHERS’ RETIRMENT SYSTEM
CONFIDENTIAL INFORMATION/QDRO
*This form must accompany all proposed qualified domestic relations orders submitted to
TRS.
Case Name: __________________________
v.
______________________________
County:
__________________________
Case Number:
__________________
TRS Member Name: ______________________________________________________
TRS Member Number: _____________
Social Security Number: __________________
Address:
__________________________________________________________________
City:
_____________________
State: __________ Zip:
__________________
Date of Birth: _______________________ Phone Number: ___________________
Name of Former Spouse:
______________________________________________________
Social Security Number:
______________________________________________________
Address:
__________________________________________________________________
City:
_____________________
State: __________ Zip:
__________________
Date of Birth: _______________________ Phone Number: __________________
Information provided by:
Signature:
_____________________________
Date: ________________________
Print Name: _____________________________
Address:
__________________________________________________________________
City:
_____________________
State: __________ Zip:
__________________
Phone Number:
_______________________
Teachers’ Retirement System/ 479 Versailles Road / Frankfort, KY 40601/ 800-618-1687/ 502-848-8500 7/2016
ADVERTISEMENT
0 votes
Related Articles
Related forms
Income Tax Withholding Preference Certificate - The California State Teachers' Retirement System
Financial
Form W-4p Kentucky Teachers' Retirement System Withholding Certificate For Pension Or Annuity Payments
Financial
Form Trf-3 Request For Direct Transfer Of Membership - New York State Teachers' Retirement System
Legal
Related Categories
Parent category: Legal