QUALIFIED DOMESTIC RELATIONS ORDER

IN THE [COURT NAME]
[COUNTY/DISTRICT] OF [JURISDICTION]
STATE OF [STATE]

IN RE THE MARRIAGE OF:

[PARTICIPANT FULL LEGAL NAME]
Petitioner,

and

[ALTERNATE PAYEE FULL LEGAL NAME]
Respondent.

CASE NO.: [CASE NUMBER]

QUALIFIED DOMESTIC RELATIONS ORDER

This Order is intended to be a Qualified Domestic Relations Order ("QDRO") as defined in Section 206(d)(3) of the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), and Section 414(p) of the Internal Revenue Code of 1986, as amended ("Code"). This Order is granted pursuant to the applicable domestic relations laws of the State of [STATE] that relate to marital property rights, child support, and/or spousal support between spouses and former spouses in matrimonial actions.

I. IDENTIFICATION OF PARTIES AND PLAN

1. Participant Information:

   • Name: [PARTICIPANT FULL LEGAL NAME]
   • Last Known Address: [PARTICIPANT ADDRESS]
   • Date of Birth: [PARTICIPANT DOB]
   • Social Security Number: [PARTICIPANT SSN - LAST FOUR DIGITS ONLY: XXX-XX-####]

2. Alternate Payee Information:

   • Name: [ALTERNATE PAYEE FULL LEGAL NAME]
   • Last Known Address: [ALTERNATE PAYEE ADDRESS]
   • Date of Birth: [ALTERNATE PAYEE DOB]
   • Social Security Number: [ALTERNATE PAYEE SSN - LAST FOUR DIGITS ONLY: XXX-XX-####]
   • Relationship to Participant: Former Spouse

3. Marriage Information:

   • Date of Marriage: [DATE OF MARRIAGE]
   • Date of Separation: [DATE OF SEPARATION]
   • Date of Divorce/Dissolution: [DATE OF DIVORCE]

4. Plan Information:

   • Plan Name: [FULL LEGAL NAME OF RETIREMENT PLAN]
   • Plan Administrator: [PLAN ADMINISTRATOR NAME]
   • Plan Administrator Address: [PLAN ADMINISTRATOR ADDRESS]
   • Plan Identification Number: [PLAN ID NUMBER]
   • Type of Plan: [SPECIFY: DEFINED BENEFIT PLAN/DEFINED CONTRIBUTION PLAN/OTHER]

II. DIVISION OF RETIREMENT BENEFITS

5. Assignment of Benefits: This Order assigns to the Alternate Payee the right to receive a portion of the Participant's benefits under the Plan as set forth below.

6. Division Method: The Alternate Payee is hereby assigned [SPECIFY PERCENTAGE]% of the Participant's total accrued benefit under the Plan as of the valuation date, or alternatively, $[DOLLAR AMOUNT] of the Participant's account balance as of the valuation date.

7. Coverture Fraction: For purposes of determining the marital portion of the Participant's benefits, the following coverture fraction shall be applied:

   Months of Plan participation during marriage
   -------------------------------------------- × Total Accrued Benefit
   Total months of Plan participation
   

   Where:

   • "Months of Plan participation during marriage" means the number of months from the later of (i) the date of marriage or (ii) the date the Participant began participating in the Plan, through the earlier of (i) the date of separation or (ii) the date of divorce.
   • "Total months of Plan participation" means the total number of months the Participant participated in the Plan through the date of the Participant's retirement or other termination of employment.

8. Valuation Date: For purposes of calculating the Alternate Payee's interest in the Participant's benefits, the valuation date shall be [VALUATION DATE: e.g., DATE OF SEPARATION, DATE OF DIVORCE, or OTHER AGREED DATE].

9. Investment Gains and Losses: The Alternate Payee's assigned portion shall [INCLUDE/NOT INCLUDE] a pro rata share of all investment earnings, gains, losses, appreciation, and depreciation from the valuation date until the date of distribution. The Alternate Payee's share shall be [INCREASED/DECREASED] in the same manner as the Participant's account balance is [INCREASED/DECREASED] due to investment experience during this period.

10. Separate Account: To the extent permitted by the Plan, the Plan Administrator shall establish a separate account for the Alternate Payee's benefit. The Alternate Payee shall have the same rights with respect to investment elections for the separate account as those available to other Plan participants, subject to the terms of the Plan.

III. PAYMENT PROVISIONS

11. Commencement of Payments: The Alternate Payee shall be entitled to commence receiving benefits at the earliest date permitted under the terms of the Plan. The Alternate Payee may elect to receive benefits as follows:

    a. For a Defined Contribution Plan: At any time after the Participant reaches the "earliest retirement age" as defined in Section 414(p)(4)(B) of the Code, or, if earlier, the date the Participant actually receives a distribution from the Plan; or

    b. For a Defined Benefit Plan: At the earliest retirement age as defined in Section 414(p)(4)(B) of the Code, or at such later date as the Alternate Payee may elect, subject to the terms of the Plan.

12. Form of Payment: The Alternate Payee may elect to receive the assigned benefits in any form of payment available to participants under the Plan, except that the Alternate Payee may not elect a form of payment that would provide benefits to a subsequent spouse of the Alternate Payee. Available forms of payment may include:

    a. A lump sum distribution;

    b. A direct rollover to an eligible retirement plan or Individual Retirement Account (IRA);

    c. Periodic payments in accordance with the Plan's provisions; or

    d. Any other form of payment available under the Plan, subject to the limitations set forth herein.

13. Early Retirement Subsidies: If the Participant elects to retire before normal retirement age and receives an early retirement subsidy or incentive, the Alternate Payee [SHALL/SHALL NOT] be entitled to a proportional share of such subsidy or incentive based on the formula set forth in Paragraph 6 above.

14. Cost of Living Adjustments: If the Participant's benefits are subject to cost of living adjustments (COLAs) after retirement, the Alternate Payee [SHALL/SHALL NOT] be entitled to a proportional share of such adjustments with respect to the benefits assigned to the Alternate Payee under this Order.

IV. CONTINGENCY PROVISIONS

15. Death of Participant Before Distribution: In the event the Participant dies before the Alternate Payee commences receipt of benefits under this Order:

    a. The Alternate Payee shall be treated as the surviving spouse of the Participant for purposes of any pre-retirement survivor benefits payable under the Plan with respect to the portion of the Participant's benefits assigned to the Alternate Payee under this Order.

    b. If the Plan does not provide for pre-retirement survivor benefits, or if such benefits are less than the amount assigned to the Alternate Payee under this Order, the Alternate Payee shall be entitled to receive the assigned portion as soon as administratively feasible following the Participant's death, subject to the terms of the Plan.

    c. The Alternate Payee's rights under this paragraph shall take precedence over the rights of any subsequent spouse of the Participant with respect to the portion of the Participant's benefits assigned to the Alternate Payee under this Order.

16. Death of Alternate Payee:

    a. If the Alternate Payee dies before commencing receipt of benefits under this Order, the benefits that would have been paid to the Alternate Payee shall [REVERT TO THE PARTICIPANT/BE PAID TO THE ALTERNATE PAYEE'S DESIGNATED BENEFICIARY/BE PAID TO THE ALTERNATE PAYEE'S ESTATE].

    b. If the Alternate Payee dies after commencing receipt of benefits under this Order, any remaining benefits shall be paid in accordance with the form of payment elected by the Alternate Payee and the terms of the Plan.

17. Remarriage Provisions: The Alternate Payee's rights to receive benefits under this Order shall not be affected by the Alternate Payee's remarriage.

18. Loan Provisions: Any outstanding loans against the Participant's account in the Plan as of the valuation date shall be [ALLOCATED PROPORTIONALLY BETWEEN THE PARTICIPANT AND ALTERNATE PAYEE/REMAIN THE SOLE RESPONSIBILITY OF THE PARTICIPANT/OTHER ARRANGEMENT]. After the valuation date, neither party shall take any loans that would impair the other party's rights under this Order.

V. TAX CONSIDERATIONS

19. Tax Treatment: For purposes of Sections 402(a)(1) and 72 of the Code, the Alternate Payee shall be treated as the distributee of any distribution or payment made to the Alternate Payee under this Order and, as such, will be responsible for any income tax liability associated with such distributions.

20. Early Withdrawal Penalties: Pursuant to Section 72(t)(2)(C) of the Code, payments made to the Alternate Payee pursuant to this Order shall not be subject to the 10% early withdrawal penalty tax, regardless of the Alternate Payee's age at the time of distribution, provided that such distributions are made pursuant to this Order.

21. Tax Reporting: The Plan Administrator shall issue appropriate tax reporting forms to the Alternate Payee for any distributions made to the Alternate Payee pursuant to this Order.

22. Constructive Receipt: Neither the Participant nor the Alternate Payee shall have constructive receipt of any benefits assigned to the other party under this Order until such benefits are actually distributed by the Plan.

VI. LEGAL REQUIREMENTS

23. QDRO Qualification Language: This Order is intended to constitute a QDRO pursuant to Section 206(d)(3) of ERISA and Section 414(p) of the Code. The parties acknowledge and agree that this Order:

    a. Creates or recognizes the existence of the Alternate Payee's right to receive all or a portion of the Participant's benefits payable under the Plan;

    b. Clearly specifies the name and last known mailing address of the Participant and the Alternate Payee;

    c. Clearly specifies the amount or percentage of the Participant's benefits to be paid to the Alternate Payee, or the manner in which such amount or percentage is to be determined;

    d. Clearly specifies the number of payments or period to which this Order applies;

    e. Clearly specifies the Plan to which this Order applies; and

    f. Does not require the Plan to provide any type or form of benefit, or any option, not otherwise provided under the Plan, does not require the Plan to provide increased benefits, and does not require the payment of benefits to the Alternate Payee that are required to be paid to another alternate payee under another order previously determined to be a QDRO.

24. Compliance with Plan Terms: Nothing in this Order shall be construed to require the Plan to:

    a. Provide any type or form of benefit or any option not otherwise provided under the Plan;

    b. Provide increased benefits (determined on the basis of actuarial value);

    c. Pay benefits to the Alternate Payee that are required to be paid to another alternate payee under another QDRO in effect prior to the effective date of this Order; or

    d. Begin payment of benefits to the Alternate Payee prior to the date that such payments can commence under the terms of the Plan and applicable law.

25. Multiple QDROs: The parties acknowledge that [THERE ARE/THERE ARE NO] other QDROs currently in effect with respect to the Participant's benefits under the Plan. If there are other QDROs in effect, this Order shall be [SUBORDINATE TO/COORDINATE WITH] such other QDROs as follows: [SPECIFY COORDINATION PROVISIONS].

VII. ADMINISTRATIVE PROVISIONS

26. Jurisdiction Retention: The Court retains jurisdiction to amend this Order to establish or maintain its status as a QDRO under ERISA and the Code, provided that no such amendment shall require the Plan to provide any type or form of benefit, or any option, not otherwise provided under the Plan, and further provided that no such amendment shall alter the amount allocated to the Alternate Payee hereunder. If the Plan Administrator determines that this Order is not a QDRO, the parties shall cooperate with the Court and the Plan Administrator to make the necessary revisions to ensure that this Order is qualified.

27. Implementation Instructions: The Plan Administrator shall take all steps necessary to implement this Order, including:

    a. Segregating the Alternate Payee's assigned portion into a separate account, if permitted under the Plan;

    b. Providing the Alternate Payee with the same information that is provided to other Plan participants regarding the terms and conditions of the Plan;

    c. Providing the Alternate Payee with election and beneficiary designation forms as appropriate; and

    d. Processing distribution requests from the Alternate Payee in accordance with the terms of the Plan and this Order.

28. Fees and Costs: Any fees charged by the Plan Administrator for the review and implementation of this Order shall be [PAID BY THE PARTICIPANT/PAID BY THE ALTERNATE PAYEE/SHARED EQUALLY BETWEEN THE PARTICIPANT AND THE ALTERNATE PAYEE].

29. Notification Requirements: Both the Participant and the Alternate Payee shall be responsible for keeping the Plan Administrator informed of their current mailing addresses at all times.

30. Copies of Plan Documents: Upon request, the Plan Administrator shall provide the Alternate Payee with copies of the Summary Plan Description and other relevant Plan documents.

VIII. SPECIAL CIRCUMSTANCES

31. Military Retirement Benefits: [IF APPLICABLE] This Order is intended to divide military retirement benefits in accordance with the Uniformed Services Former Spouses' Protection Act (USFSPA). The following special provisions apply:

    a. The Participant is a member or former member of the [BRANCH OF SERVICE];

    b. The Alternate Payee is entitled to [PERCENTAGE]% of the Participant's disposable retired pay;

    c. If the Participant's retirement is based on disability, the Alternate Payee [SHALL/SHALL NOT] receive a proportionate share of the disability benefits;

    d. The Alternate Payee [SHALL/SHALL NOT] be entitled to receive cost-of-living adjustments on the Alternate Payee's share of the Participant's retired pay;

    e. This Order shall be forwarded to the Defense Finance and Accounting Service (DFAS) for implementation.

32. Federal Employee Retirement Benefits: [IF APPLICABLE] This Order is intended to divide federal employee retirement benefits. The following special provisions apply:

    a. For FERS/CSRS Benefits: i. The Alternate Payee is entitled to [PERCENTAGE]% of the Participant's gross monthly annuity under the [FERS/CSRS] retirement system; ii. The Alternate Payee [SHALL/SHALL NOT] be entitled to a proportionate share of the Participant's cost-of-living adjustments; iii. The Alternate Payee [SHALL/SHALL NOT] be entitled to a former spouse survivor annuity equal to [PERCENTAGE]% of the Participant's full survivor annuity;

    b. For Thrift Savings Plan (TSP) Benefits: i. The Alternate Payee is entitled to [PERCENTAGE]% of the Participant's TSP account balance as of [VALUATION DATE]; ii. The Alternate Payee's share [SHALL/SHALL NOT] include earnings and losses from the valuation date until the date of distribution; iii. This Order shall be forwarded to the TSP Service Office for implementation.

33. Multiple Retirement Plans: [IF APPLICABLE] This Order applies to multiple retirement plans as follows:

    a. The division of benefits described in Section II applies separately to each of the following plans in which the Participant participates: i. [PLAN NAME 1] ii. [PLAN NAME 2] iii. [ADDITIONAL PLANS AS NECESSARY]

    b. A separate copy of this Order shall be filed with each Plan Administrator.

    c. The combined total of all benefits received by the Alternate Payee from all plans shall not exceed the amount or percentage specified in Paragraph 6 of this Order.

34. Self-Employed Retirement Plans: [IF APPLICABLE] This Order applies to self-employed retirement plans as follows:

    a. For SEP IRA or SIMPLE IRA: i. The Alternate Payee is entitled to [PERCENTAGE]% of the Participant's account balance as of [VALUATION DATE]; ii. The division shall be accomplished by a direct transfer from the Participant's account to an IRA established by the Alternate Payee;

    b. For Solo 401(k) Plan: i. The Alternate Payee is entitled to [PERCENTAGE]% of the Participant's account balance as of [VALUATION DATE]; ii. The division shall be accomplished in accordance with the plan document and applicable law.

IX. MISCELLANEOUS PROVISIONS

35. Integration with Divorce Decree: This Order is issued pursuant to the [JUDGMENT OF DISSOLUTION/DIVORCE DECREE/SEPARATION AGREEMENT] entered on [DATE] in Case No. [CASE NUMBER]. In the event of any conflict between the terms of this Order and the terms of the [JUDGMENT OF DISSOLUTION/DIVORCE DECREE/SEPARATION AGREEMENT], the terms of this Order shall control with respect to the division of retirement benefits.

36. No Guarantee of Benefits: Nothing in this Order shall be construed as a guarantee by the Plan, the Plan Administrator, the Participant, or the Alternate Payee that benefits will be available for division at any particular time or in any particular amount. The division of benefits under this Order is subject to the terms of the Plan and applicable law.

37. Cooperation: The Participant and the Alternate Payee shall cooperate fully with each other and with the Plan Administrator to effectuate the intent of this Order, including executing any additional documents that may be necessary or appropriate.

38. Severability: If any provision of this Order, or any portion thereof, is held to be invalid, illegal, void, or unenforceable by any court or tribunal of competent jurisdiction, the remainder of this Order shall remain in full force and effect to the maximum extent permitted by law. The parties agree that any such invalid, illegal, void, or unenforceable provision shall be modified and limited in its effect to the extent necessary to cause it to be enforceable, or if such modification is not possible, shall be deemed severed from this Order. In such event, the parties shall negotiate in good faith to replace any invalid, illegal, void, or unenforceable provision with a valid, legal, and enforceable provision that corresponds as closely as possible to the parties' original intent and economic expectations.

39. Binding Effect: This Order shall be binding upon the heirs, successors, and assigns of the Participant and the Alternate Payee.

40. Effective Date: This Order shall become effective immediately upon its entry by the Court.

IT IS SO ORDERED.

DATED: ________________________

JUDGE OF THE [COURT NAME]

APPROVED AS TO FORM AND CONTENT:

[PARTICIPANT NAME] Petitioner

[PARTICIPANT'S ATTORNEY NAME] Attorney for Petitioner

[ALTERNATE PAYEE NAME] Respondent

[ALTERNATE PAYEE'S ATTORNEY NAME] Attorney for Respondent