Free Qualified Domestic Relations Order - Arizona


File Size: 23.2 kB
Pages: 3
Date: August 27, 2008
File Format: PDF
State: Arizona
Category: Court Forms - Local
Author: ACAP User
Word Count: 886 Words, 6,233 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://pinalcountyaz.gov/Departments/JudicialBranch/ClerkoftheCourt/Documents/Downloads/FamilyLaw/Form37.pdf

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Your Name: Your Mailing Address: Your City, State, ZIP: Your Telephone No: Attorney's Bar No: Self (Without Attorney) Representing

Petitioner

Respondent

IN THE SUPERIOR COURT OF ARIZONA PINAL COUNTY
Case No. DO2

In re the Matter of:

(Name of Petitioner) AND

QUALIFIED DOMESTIC RELATIONS ORDER

(Name of Respondent)

This Order is intended to be a "Qualified Domestic Relations Order" as such term is defined in §206(d) of the Employee Retirement Income Security Act of 1974 ("ERISA") and in §414(p) of the Internal Revenue Code of 1986 (the "Code). Any ambiguity, uncertainty or inconsistency in this Order shall be interpreted so as to ensure its status as a Qualified Domestic Relations Order under such sections. The Court, being fully advised of the premises, find, orders, adjudges and decrees as follows: 1. This Order relates to the marital property rights of the spouses under the community property laws of this State. 2. Petitioner / Respondent (circle one) is the participant in the Pension Plan for (employer's name), a plan qualified under §401 of the Code adopted by his employer (the "Pension Plan"). 3. (a) The participant spouse is the Petitioner / Respondent (circle one) in these proceedings, ______________ , (the "Participant"), whose last known mailing address, date of birth and is:

_____________________________________ _____________________________________ _____________________________________ _____________________________________

© Superior Court of Arizona in Pinal County January 13, 2006 ALL RIGHTS RESERVED

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(b)The alternate payee is the Petitioner / Respondent (circle one) in these proceedings, ____________________________________, (the "Alternate Payee", whose last known mailing address, date of birth is:

_____________________________________ _____________________________________ _____________________________________ _____________________________________

(c) There are no other alternate payees with respect to Participant's interest in the Pension Plan.

4. (a) Alternate Payee shall be entitled to the actuarial equivalent of (1) Fifty Percent (50%) of Participant's accured benefit in the Pension Plan as of _____________________ (date). (2) any early retirement subsidy which Participant may then be entitled to or may later be entitled to with respect to Alternate Payee's share of such benefits, and (3) any improvements, benefits updates or cost-of-living adjustments on Alternate Payee's share of such benefits, and the Pension Plan shall account for such benefit as the separate benefits of the Alternate Payee. The amount to be distributed to the Alternate Payee at the time provided in paragraph 7 shall be the actuarial equivalent of such amount determined under the actuarial assumptions of the Pension Plan at the time Alternate Payee begins to receive a distribution. (b) If Participant predeceases Alternate Payee, and before payment of the Alternate Payee's interest has been made or begun under paragraph 7, prior to her/his retirement, Alternate Payee shall be entitled to her/his proportionate share of Participant's interest in the Pension Plan's preretirement survivor annuity benefits. (c) If Participant predeceases Alternate Payee, and before payment of the Alternate Payee's interest has been made or begun under paragraph 7, after her/his retirement benefits have begun, Alternate Payee shall be entitled to her/his proportionate share in any of Participant's post-retirement death under the terms of the Pension Plan and same are awarded to Alternate Payee. 5. This Order does not apply to a specific number of payments or to a specific period but rather is intended to provide Alternate Payee with a benfit based on a percentage of Participant's accured benefits in the Pension Plan. 6. This Order applies to the Pension Plan for ______________________________(employer's name). 7. The Pension Plan shall make a distribution, in accordance with the terms of the Pension Plan, to Alternate Payee at the time and in the form requested by Alternate Payee. The time of distribution and form requested by Alternate Payee shall conform to the requirements of the Pension plan. Alternate Payee shall not be entitled to receive a distribution until the time that Participant would be eligible to receive a benefits.

© Superior Court of Arizona in Pinal County January 13, 2006 ALL RIGHTS RESERVED

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8. If requested prior to distribution by the Plan Administrator pursuant to §411(a)(11) of the Code and §203(e) of ERISA, Alternate Payee shall execute a written consent to the distribution from the Pension Plan. Alternate Payee shall be entitled to elect against federal withholding taxes but only to the extent provided by §3405 of the Code and as otherwise permitted by the Pension Plan. 9. The Court retains jurisdiction to amend this Order but only for the purpose of establishing or maintaining its qualification as a Qualified Domestic Relations Order under ERISA and the Code and to supervise the payment of retirement benefits as provided herein to Alternate Payee; provided that no such amendment shall require the Pension Plan to provide any type or form of benefits, or any option, not otherwise provided under the Pension Plan, nor require the Pension Plan to provide increased benefits nor invalidate this Order as "Qualified" under ERISA. 10. Alternate Payee shall pay, when due, and hold Participant free and harmless from any income tax or other liability or obligation resulting from the distribution of proceeds from the Pension Plan to or for her/his. 11. A true copy of this Order shall be served upon (employer's name and address):

_____________________________________ _____________________________________ _____________________________________ _____________________________________

Dated this __________ day of __________________________, ___________.

____________________________________ Judge of Superior Court

© Superior Court of Arizona in Pinal County January 13, 2006 ALL RIGHTS RESERVED

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