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ODEL

OMESTIC

ELATIONS

RDER

The Teachers’ and State Employees’ Retirement System

WHEREFORE, based upon the foregoing Findings of Fact, the Court concludes as a

matter of law that the non-member ex-spouse is entitled to the entry of an Order directing the

distribution, in the manner set forth, to him/her of his/her marital share of a portion of all

benefits payable by the Retirement System to the member.

IT IS THEREFORE ADJUDGED, ORDERED, AND DECREED:

The term “member” refers to plaintiff/defendant herein, and the term “non-

member ex-spouse” refers to plaintiff/defendant herein.

That the name, last known mailing address, redacted social security number (xxx-

xx-_____), and date of birth of the member are: ___________________________.

That the name, last known mailing address, redacted social security number (xxx-

xx-_____), and date of birth of the non-member ex-spouse are:

______________________________.

That the name and mailing address of the Retirement System to which this Order

is directed are: The Teachers’ and State Employees’ Retirement System of North Carolina,

Retirement Systems Division, Department of State Treasurer, 3200 Atlantic Ave., Raleigh, North

Carolina, 27604.

The Retirement System shall distribute to the non-member ex-spouse his/her

marital share of the member’s benefits payable by the Retirement System, calculated pursuant to

the provisions of Findings of Fact 4 and 5 of this order. In the event that a return of

accumulated contributions becomes payable pursuant to G.S. 135-5(f) or G.S. 135-5(g1), then the

Retirement System shall distribute to the non-member ex-spouse his/her marital share of such a

return of accumulated contributions, calculated pursuant to the provisions of Finding of Fact 5

of this order.

The non-member ex-spouse shall receive his/her share of the member’s

retirement benefits at such time and in such payment form as said benefits are paid to the

member.

In the event that the non-member ex-spouse predeceases the member or the

member’s designated survivor for a retirement benefit, if any, the non-member ex-spouse’s

marital share of the member’s retirement benefits shall revert to the member.

In the event that the Retirement System inadvertently pays to the member any

benefits that are awarded to the non-member ex-spouse pursuant to the terms of this Order, the

member shall immediately reimburse the non-member to the extent that he/she has received such

benefit payments, and shall forthwith pay such amounts so received directly to the non-member

Model Domestic Relations Order - The Teachers' And State Employees' Retirement System Page 3