Instructions For Tier One Tier Two And Iap Account No Award To Former Spouse printable pdf download

11410 SW 68th Parkway, Tigard OR 97223

Mailing Address – PO Box 23700, Tigard OR 97281-3700

Phone – 503-598-7377 toll free – 888-320-7377

Fax – 503-598-0561 website –

Instructions for Tier One/Tier Two and IAP Account

(Non-Retired Member) No Award to Former Spouse

The attached form is strictly for Tier One/Tier Two members who have been awarded the full retirement beneﬁ ts associ-

ated with their Tier One/Tier Two and/or IAP accounts. The IAP program began January 1, 2004. OPSRP members who

have a pension beneﬁ t as well as IAP account are addressed on a different form.

If a former spouse is awarded any portion of the member’s Tier One/Tier Two or IAP account(s), you may need one of the

following forms:

•

PERS Tier One/Tier Two Non-Retired Member Divorce Award of Separate Account to Alternate Payee

•

PERS Tier One/Tier Two Alternate Payee Divorce Award of Payment Reduction or Deduction Method (Non-Retired)

•

Individual Account Program (IAP) Non-Retired Member Divorce Award of Separate Account(s) to Alternate Payee

When used in this form, the term ‘former spouse’ refers to the former wife, former husband, or other person whom the

court order treats or directs PERS to treat the same as a spouse.

General information

•

The divorce forms online ( /mem/pages/section/form/divorce_forms.aspx) are PDF fill-in

forms. You can also complete a hard copy. Once completed, print the form and attach as an exhibit to your court order.

•

Type or print clearly in dark ink. Illegible forms could be returned, which could delay the request.

•

Do not change anything on the form; alterations could void the form.

•

Attach the Tier One/Tier Two and IAP Account (Non-Retired Member) No Award to Former Spouse form as an ex-

hibit to the court order, and submit to the courts. Send the ﬁ nal ﬁ led court order to PERS.

Section A: Member and former spouse information

(Type or print clearly in dark ink.)

•

Enter the member’s full name.

•

Enter the member’s PERS number, the last four digits of a Social Security number, or a date of birth.

•

Enter the former spouse’s full name.

Section B: Non-retired member beneﬁ ts awarded to member

If the courts awarded the member all of his/her Tier One/Tier Two or IAP accounts and/or future retirement beneﬁ ts,

check the appropriate box(es) in this section.

Important beneficiary information

If the former spouse does not retain a beneficiary interest, please submit updated beneficiary designation forms. Should

the member die before retirement, PERS will comply with the most recent valid beneﬁ ciary

designation form on ﬁ le to determine the beneﬁ ciary for the member’s Tier One/Tier Two and IAP accounts.

Tier One/Tier Two

To change the beneﬁ ciary designation on a PERS Tier One/Tier Two account, the member must complete the

PERS Tier

One/Tier Two Pre-Retirement Beneﬁ ciary Designation

form. If there is no valid designation of beneﬁ ciary on ﬁ le, the

pre-retirement death beneﬁ t is payable to the member’s estate.

IAP Beneﬁ ciary

To change the beneﬁ ciary designation on an IAP account, the member must complete the

IAP Pre-Retirement Designa-

tion of Beneﬁ ciary Packet

If a member fails to designate a beneﬁ ciary or if the beneﬁ ciary dies before the member, the

order of distribution is by statute: to the spouse or constitutional equivalent of a spouse, to the surviving children, or to

the estate.

In compliance with the Americans with Disabilities Act, PERS will provide help filling out this form upon request. You can request help by phoning 503-598-7377, toll free 888-320-7377,

or TTY 503-603-7766.

Instructions for form #459-564a (6/13/2013) SL3 IIM Code: 9981

Instructions For Tier One Tier Two And Iap Account No Award To Former Spouse

Related Articles

Related forms

Related Categories