Division Of Property Order (Page 3 of 7) in pdf

Division Of Property Order Page 3

Disability monthly benefit

Account refund

Additional money purchase annuity/additional annuity lump sum refund

Reemployed retiree money purchase annuity (when monthly payment exceeds

$25.00) or lump sum refund

Defined contribution plan benefit

Method of Payment: If the Plan Participant is a reemployed retiree contributing to a

money purchase annuity or is eligible to receive or is receiving monthly benefits or a

lump sum payment from a reemployed retiree money purchase annuity, the Alternate

Payee shall receive payment from the reemployed retiree money purchase annuity and

any other type of payment designated in Paragraph II(A) above in a monthly or one-time

dollar amount as specified in Paragraph II(B)(1)(a) below. If the Plan Participant is

participating in the defined contribution program, or any of its constituent plans, the

Alternate Payee shall receive payment from the defined contribution program, or any of

its constituent plans, and any other type of payment designated in Paragraph II(A) above

in a percentage of a fraction as specified in Paragraph II(B)(2) below. If the Plan

Participant is participating in any other plan in a Public Retirement Program, the

Alternate Payee shall receive payment in either a dollar amount OR a percentage of a

fraction as specified below (i.e. Please complete Dollar Amount OR Percentage).

Dollar Amount:

Paragraphs II(B)(1)(a) and (b) must be fully completed,

even if the indication is to pay the Alternate Payee “$0.00” from the Participant’s

periodic benefit or/and lump sum payment.

If the Participant elects a plan of payment that consists of a lump sum

payment OR a plan of payment that consists of periodic benefits:

$_______________ per benefit from the Participant’s periodic benefit

upon the Participant’s receipt of the aggregate periodic benefit; or

$_______________ from the Participant’s lump sum payment upon the

Participant’s receipt of the payment.

Division Of Property Order Page 3