Fill and Sign the 128574 Fl 460 Qualified Domestic Relations Order for Support Form

FL-4 60ATTO RNEY O R P AR TY W IT H O UT A TTO RNEY O R G OVER NM EN TA L A G EN CY ( p urs u ant to F am . C ode, § § 1 7400,1 7406) (N am e, s ta te b ar n um ber, a nd a ddre ss):F O R C O URT U SE O NLY)T E LE PH O NE N O .:F A X N O .:A TTO RNEY F O R ( N am e):S U PER IO R C O URT O F C ALIF O RNIA , C O UNTY O FSTR EET A D DR ESS:M AIL IN G A D D RESS:C IT Y A N D Z IP C O DE:BR AN CH N AM E:P ETIT IO NER /P LA IN TIF F:R ESPO NDEN T/D EFE N DAN T:O TH ER P AR EN T:Q UALIF IE D D O M ESTIC R ELA TIO NS O RDER F O R S U PPO RT (EA RNIN G S A SSIG NM EN T O RDER F O R S U PPO RT)CASE N UM BER :M odif ic atio nC hild S upportS pousal o r F am ily S upportT O T H E P A YO R/P LA N: T his is a n e arn in gs a ssig nm ent o rd er f o r s u pport g ove rn ed b y C hapte r 8 o f t h e F am ily C ode a nd is in te nded t ob e a q ualif ie d d om estic r e la tio ns o rd er ( Q DRO ) u nder a pplic a ble f e de ra l la w . T his o rd er a pplie s t o t h e f o llo w in g n am ed P la n:N am e:A ddre ss:T his o rd er r e quir e s y o u t o w it h hold a p ortio n o f t h e b enefit s p aya ble u n der t h e P la n w it h r e sp ect t o ( s p ecif y O blig orlP artic ip ant's f u llle gal n am e, a nd, if k n ow n, m ailin g a ddre ss, d ate o f b ir th , a nd e m plo ye e id entif ic a tio n n um ber):N am e:D O B:ID #:A ddre ss:a nd p ay a s d ir e cte d b elo w .Note: A separate Attachment to Qualified Domestic Relations Order for Support (form FL-461) that sets forth the social security number of any participant named above must be completed and served on the Plan with a copy of this order. The Plan will require this information for tax reporting purposes. Do not file a copy of form FL-461 with the court.TH E C O URT O RDER S T H E F O LLO W IN G :1. WITHHOLDING OF PERIODIC BENEFIT PAYMENTSa. I f P artic ip ant h as c o m mence d r e ce iv in g b enefit s u nder t h e P la n in t h e f o rm o f m onth ly o r o th er p erio dic p aym ents o r h as a pplie d to r e ce iv e m onth ly o r o th er p erio dic p aym ents ( if b enefit s a re n ot in p ay s ta tu s a nd h ave n ot b een a pplie d f o r, s e e it e m 5 ; if be ne fit s a re p aya ble in a lu m p s u m , s e e it e m 3 ), w it h hold t h e f o llo w in g a m ounts f r o m t h e m onth ly b enefit s o th erw is e p aya ble t o th e P artic ip ant:(1)$p er m onth c u rre n t c h ild s u pport pe r m onth c u rre n t s p ousal s u pport pe r m onth c u rre n t f a m ily s u pport(4 )$(2 )$(5)$(3 )$(6 )$p er m onth c h ild s u pport a rre ara g es per m onth s p ousal s u pport a rre ara g es per m onth f a m ily s u pport a rre ara gesb. TOTAL MONTHLY SUPPORT OBLIGATION OF (sum of items la(l) through la(6)):$c . I f t h e T O TA L M ONTH LY S U PPO RT O BLIG ATIO N e xce eds 5 0% o f P artic ip ant's p erio dic b enefit s , w it h hold t h e g re ate r o f 5 0% or t h e p erc e nta ge, if a ny, s e t f o rth in I te m 1 2.d. I f P artic ip ant's b enefit s a re p aya ble o n a p erio dic b asis o th er t h an m onth ly ( e .g ., q uarte rly , s e m i- a nnually , o r a nnually ), m ult ip ly ea ch o f t h e a m ounts in it e m s 1 a a nd 1 b b y t h e n um ber o f m onth s in clu ded in t h e p aym ent p erio d a nd w it h hold t h e a dju ste d am ou nts ( s u b je ct t o t h e lim it a tio ns in it e m 1 c , t a kin g in to a cco un t t h e a dju stm ent o f t h e a m ount in it e m 1 b ) f r o m e ach b enefit pa ym ent.e . I f t h e a m ount w it h held is le ss t h an t h e T O TA L M ONTH LY S U PPO RT O BLIG ATIO N, p ro ra te t h e a m ount f ir s t t o c u rre nt c h ilds u pport, t h en t o c u rre nt f a m ily s u pport, a nd t h en t o c u rre nt s p ousa l s u pport. A pply a ny r e m ain der in t h e s a m e o rd er o f p rio rit y t o su pport a rre ara ges.Page one of fourQ UALIF IE D D O M ESTIC R ELA TIO NS O RDER F O R S U PPO RT (EA RNIN G S A SSIG NM EN T O RDER F O R S U PPO RT)Fam ily C ode, § 5 208; C ode o fC iv il P ro ce dure , § 7 06.0 52,26 U .S .C . § 4 14(p ); 2 9 U .S .C . § 1 056(d )Form Adopted by for Optional Use Judicial Council of California FL-460 [Rev. January 1, 2003]ele ctr o n ic f o rm  2 002 WWW.LawCA.com La w P ublis h ersele ctr o n ic f o rm  2 002 WWW.LawCA.com La w P ublis h ers PETIT IO NER /P LA IN TIF F:CASE N UM BER :R ESPO NDEN T/D EFE N DAN T:O TH ER P AR EN T:2 . A R REA RAG ES : F or p urp ose s o f t h is o rd er, t h e t o ta l a rre ara ges a re s e t a s f o llo w s ( in te re st t h at h as n ot b een c a lc u la te d o r in clu ded is n o t w aiv e d):)A m ountA s o f ( d a te )a.C hild s u p port:$b .S pousa l s u pport:$C .F am ily s u pport:$3 . W IT H HO LD IN G F R O M L U M P S U M D IS TR IB UTIO NS: W it h hold f r o m a ny lu m p s u m d is tr ib utio ns c u rre ntly p aya ble t o P artic ip ant unde r t h e P la n a s f o llo w s:a . A n a m ount e qu al t o t h e t o ta l o f t h e s u pport a rre ara ges, if a ny, s e t f o rth in it e m 2 . b. T o t h e e xte nt t h e a m ounts w it h held u nder it e m 3 a a re f o r c h ild s u pp ort a rre ara ges, w it h hold f r o m t h e lu m p s u m d is tr ib utio n a nd pay o ve r t o t h e a ppro pria te t a xin g a uth orit ie s a n a ddit io nal a m ount s u ffic ie nt t o s a tis fy t h e P la n's m andato ry f e dera l a nd s ta te in co m e t a x w it h hold in g o blig atio ns w it h r e sp ect t o t h ose a rre ara g es a nd w it h r e sp ect t o a ll a ddit io nal a m ounts w it h held u nder this it e m 3 b. A ny a m ounts w it h held u nder t h is it e m 3 b s h all n ot b e a pplie d t o r e duce t h e a m ount o f t h e c h ild s u pport a rre ara ges.c. T o t h e e xte nt t h e a m ounts w it h h eld u nder it e m 3 a a re f o r s u pport a rre ara ges o th er t h an c h ild s u pport, w it h hold f r o m t h osea m ounts a nd p ay o ve r t o t h e a ppro pria te t a xin g a uth orit ie s a n a ddit io n al a m ount s u ffic ie nt t o s a tis fy t h e P la n's m andato ry f e dera l and s ta te in co m e t a x w it h hold in g o blig atio ns w it h r e sp ect t o t h ose a rre ara ges. A ny a m ounts w it h held u nder t h is it e m 3 c s h all b e applie d p ro portio nally t o r e duce t h e a m ount o f t h e f a m ily s u pport a rre ara ges a nd s p ousa l s u pport a rre ara ges.C l. I f t h e a m ounts w it h held u nder it e m 3 a a re le ss t h an t h e t o ta l o f t h e s u pport a rre ara ges, if a ny, s e t f o rth in it e m 2 , p ro ra te t h e am ounts f ir s t t o c h ild s u pport a rre ara ges, t h en t o f a m ily s u pport a rre ara ges, a nd t h en t o s p ousa l s u pport a rre ara ges.e . I f t h e a m ounts t o b e w it h held u nder it e m s 3 a a nd 3 b w ould e xce ed t h e t o ta l a m ount o f t h e lu m p s u m d is tr ib utio n c u rre ntlyp aya ble , w it h hold t h e e ntir e a m ount o f t h e lu m p s u m d is tr ib utio n, a llo ca te t h ere fr o m a n a m ount s u ffic ie nt t o s a tis fy t h e P la n's ma ndato ry f e dera l a nd s ta te in co m e t a x w it h hold in g o blig atio ns w it h r e sp ect t o t h e a m ount o f s u ch d is tr ib utio n, a nd a llo ca te t h e bala nce t o s a tis fa ctio n o f t h e c h ild s u pport a rre ara ges. A ny in co m e t a x w it h held u nder t h is it e m 3 e s h all n ot b e a pplie d t o r e duce th e a m ou nt o f t h e c h ild s u pport a rre ara ges.f. T he lim it a tio ns o n w it h hold in g s e t f o rth in it e m 1 a nd it e m 1 2 d o n ot a pply t o t h e w it h hold in g p ro vis io ns o f t h is it e m 3 .4. DISTRIBUTE AMOUNTS WITHHELD OR ALLOCATED AS FOLLOWS:a. C hild S upport: A ll a m ounts w it h held o r p aya ble f o r c h ild s u pport u nder t h is o rd er a re f o r t h e b enefit o f ( s p ecif y n am e(s ) o f e achA lt e rn ate P aye e, w it h d ate o f b ir th , if a va ila ble ):N am e o f e ach c h ildD ate o f b ir th o f e ach c h ildb . A m ounts w it h he ld f o r c h ild s u pp ort s h all b e p aid t o ( s p ecif y n am e, c a pacit y , a nd m ailin g a ddre ss o f a gent t o r e ce iv e p aym ents ) (h ere in afte r ''A gent'') :N am e:C apacit y :A ddre ss:c. Spousal or Family Support(1 ) A ll a m ounts w it h held o r p aya ble f o r s p ousa l/ fa m ily s u pport u nder t h is o rd er a re f o r t h e b enefit o f ( s p ecif y n am e o f S pousa l o rF am ily A lt e rn ate P aye e, w it h d ate o f b ir th , if a va ila ble ):N am e:D O B:N ote : A s e para te S ta te m ent o f C onfid entia l I n fo rm atio n t h at s e ts f o rth t h e s o cia l s e cu rit y n um ber o f a ny S pousa l o r F am ily Alt e rn ate P aye e n am ed in it e m 4 c(l) m ust b e c o m ple te d a nd s e rv e d o n t h e P la n w it h a c o py o f t h is o rd er. T he P la n w ill r e -quir e t h is in fo rm atio n f o r t a x r e portin g p urp ose s. D o n ot f ile a c o py o f t h e S ta te m ent o f C onfid entia l I n fo rm atio n w it h t h e c o urt.( 2 ) A m ounts w it h held f o r s p ousa l/ fa m ily s u pport s h all b e p aid t o ( c h eck o ne):(a )S pousa l o r F am ily A lt e rn ate P aye e a t t h e f o llo w in g a ddre ss ( s p ecif y m ailin g a ddre ss o f A lt e rn ate P aye e):A ddre ss:(b )S pousa l o r F am ily A lt e rn ate P aye e's A gent ( s p ecif y n am e, c a pacit y , a nd m ailin g a ddre ss o f a gent t o r e ce iv e p aym ents ):N am e:C apacit y :A ddre ss:Q UALIF IE D D O M ESTIC R ELA TIO NS O RDER F O R S U PPO RT (EA RN IN G S A SSIG NM EN T O RDER F O R S U PPO RT)Page two of fourele ctr o n ic f o rm  2 002 WWW.LawCA.com La w P ublis h ersFL-460 [Rev. January 1, 2003] PETIT IO NER /P LA IN TIF F:CASE N UM BER ,R ESPO NDEN T/D EFE N DAN T:O TH ER P AR EN T:5.IF B EN EFIT S A RE N O T C URREN TLY I N P A Y S TA TU S:a. I f P artic ip ant a pplie s f o r b enefit s ( in clu din g a lu m p s u m d is tr ib utio n) w it h in 9 0 d ays a fte r t h e P la n r e ce iv e s t h is o rd er o r w hilet h e t e m pora ry r e str a in in g o rd er in it e m 1 3 r e m ain s in e ffe ct, t h e w it h hold in g p ro vis io ns o f t h is o rd er s h all t a ke e ffe ct o nce s u ch be nefit s b eco m e p aya ble .b. I f P artic ip ant h as n ot c o m mence d r e ce iv in g b enefit s u nder t h e P la n ( o th er t h an b y r e aso n o f t h e t e m pora ry r e str a in in g o rd er init e m 1 3), a nd d oes n ot a pply t o r e ce iv e b enefit s b y t h e e nd o f t h e p erio d s p ecif ie d in it e m 5 a, t h e P la n s h all h ave n o o blig atio n under t h is o rd er t o w it h hold p aym ents f r o m P artic ip ant's b enefit s , p ro vid ed t h e P la n s e nds p ro m pt w rit te n n otic e t o A lt e rn ate Pa ye e(s ) s ta tin g t h at n o b enefit s a re c u rre ntly a va ila ble f o r d is tr ib utio n u nder t h is o rd er a nd s p ecif y in g t h e e arlie st d ate o n whic h P artic ip ant c o uld b egin r e ce iv in g b enefit s u nder t h e P la n if P artic ip ant t e rm in ate d e m plo ym ent.6 .A ny n otic e s r e quir e d o r p erm it te d u nder t h is o rd er t o a ny A lt e rn ate P aye e s h all b e s e nt b y f ir s t- c la ss m ail, p osta ge p re paid , t o t h e Alt e rn ate P aye e o r t o t h e A lt e rn ate P aye e's A gent, if o ne is d esig nate d , a t t h e a ddre ss s e t f o rth in it e m 4 , o r s u ch o th er a ddre ss a s the A lt e rn ate P aye e/A gent m ay s p ecif y b y w rit te n n otic e t o t h e P la n.7.T his o rd er s h all, u pon a ppro va l a s a Q DRO ( c h eck a ppro pria te b ox, if e it h er is a pplic a ble ):(a )(b )a m end/r e pla ce a n y e xis tin g Q DRO w it h r e sp ect t o s u pport f o r a ny A lt e rn ate P aye e(s ) n am ed h ere in . supple m ent b ut n ot a m end/r e pla ce a ny e xis tin g p aym ent o blig atio ns u nder a p re vio us Q DRO is su ed w it h r e sp ect t o a ny Alt e rn ate P aye e n am ed h ere in .8.T his o rd er s h all n ot b e in te rp re te d t o r e quir e p aym ent o f b enefit s in a ny f o rm n ot p erm it te d b y t h e P la n o r in a n a m ount in e xce ss of t h e a ctu aria l v a lu e o f P artic ip ant's b enefit s , le ss a ny b enefit s o th erw is e p aya ble t o a noth er a lt e rn ate p aye e u nder a noth er o rd er pre vio usly d ete rm in ed t o b e a Q DR O .9.U pon a pp ro va l o f t h is o rd er a s a Q DRO , t h e P la n s h all s e nd t o A lt e rn ate P aye e(s ) a ny f o rm s o r n otic e s t h at t h e P la n m ay r e quir e in o rd er t o e ffe ctu a te t h e d is tr ib utio n o f b enefit s a s s p ecif ie d h ere in . T his r e quir e m ent d oes n ot a pply if it e m 5 b a pplie s.1 0 . T his o rd er a ffe cts a ll b enefit s o f P artic ip ant p aya ble b egin nin g a s s o on a s p ossib le b ut n ot la te r t h an 1 0 d ays a fte r y o u r e ce iv e it ,in clu din g a ny r e tr o activ e b enefit p a ym ents , w heth er t h ose p aym ents r e la te t o a p erio d b efo re o r a fte r t h e d ate y o u r e ce iv e t h is or d er. Y ou m ust w it h hold f r o m r e tr o activ e b enefit p aym ents a cco rd in g t o t h e p ro vis io ns o f it e m 1 a s if t h e p aym ents h ad b een made w hen d ue. T he p aym ents o rd ere d h ere in s h all c o ntin ue u ntil f u rth er c o urt o rd er o r n ota riz e d w rit te n n otic e f r o m t h e A lt e rn ate Pa ye e(s ).1 1. T he P la n s h all g iv e t h e O blig or/P artic ip ant a c o py o f t h is o rd er a n d t h e a cco m panyin g b la nk R equest f o r H earin g R egard in g W age and E arn in gs A ssig nm ent ( fo rm 1 299.2 8) w it h in 1 0 d ays.1 2.M AXIM UM W IT H HO LD IN G P ER C EN TA G E G REA TE R T H AN 5 0% ( if a m axim um w it h hold in g p erc e nta ge g re ate r t h an 5 0% has b een a uth oriz e d b y c o urt o rd e r, c h eck t h e b ox t o t h e le ft a nd c o m ple te t h e f o llo w in g):B y o rd er e nte re d o n ( d ate ):, p urs u ant t o s tip ula tio n o r f o llo w in g n otic e d m otio n a ndappro pria te p ro ce e din gs, t h e c o urt h as d ete rm in ed, p urs u ant t o C ode o f C iv il P ro ce dure s e ctio n 7 06.0 52, t h at b eca usesu pport a rre ara ges e xis t a nd/o r w hen P artic ip ant's d is p osa ble e arn in gs f r o m a ll s o urc e s a re t a ke n in to a cco unt, t h em axim um p erc e nta ge o f P artic ip ant's b enefit s u nder t h e P la n t h at a re s u bje ct t o w it h hold in g p urs u ant t o it e m 1 o f t h is o rd er is (c h eck o ne):(a )100%(b )% ( If t h is b ox is c h ecke d, f ill in t h e m axim um p erc e nta ge s p ecif ie d in t h e o rd er)13. TEMPORARY RESTRAINING ORDER: During any period in which the status of this order as a QDRO is being determined (by the P la n, a c o urt o f c o m pete nt ju ris d ic tio n, o r o th erw is e ) a nd s u ch f u rth er p erio d a s m ay b e o rd ere d b y t h e c o urt, t h e P la n is he re by T E M PO RAR IL Y R ESTR AIN ED f r o m m akin g a ny d is tr ib utio n t o P artic ip ant o r P artic ip ant's b enefic ia ry ( o th er t h an a be ne fic ia ry u nder a noth er Q DRO ) o f a ny a m ount t h at w ould h a ve b een p aya ble d urin g s u ch p erio d t o a ny A lt e rn ate P aye e n am ed here in if t h is o rd er h ad b een d ete rm in ed t o b e a Q DRO . I n n o e ve nt s h all t h is t e m pora ry r e str a in in g o rd er r e m ain in e ffe ct f o r a pe rio d o f m ore t h an 1 8 m onth s a fte r t h e d ate o f t h is o rd er.14. OTHER PROVISIONS(a )(b )T he P la n s h all p ro vid e t o A lt e rn ate P aye e, o r t o A lt e rn ate P aye e's A gent, a c o py o f t h e S um mary P la n D escrip tio n, a nd any s u bse quent S um marie s o f M ate ria l M odif ic a tio ns w it h r e sp ect t o t h e P la n, a nd t h e P la n's Q DRO p ro ce dure s, if a ny. Oth er ( s p ecif y ):D ate :JU DIC IA L O FFIC ERQ UALIF IE D D O M ESTIC R ELA TIO NS O RDER F O R S U PPO RT (EA RNIN G S A SSIG NM EN T O RDER F O R S U PPO RT)Page three of fourele ctr o n ic f o rm  2 002 WWW.LawCA.com La w P ublis h ersFL-460 [Rev. January 1, 2003] PETIT IO NER /P LA IN TIF F:CASE N UM BER :R ESPO NDEN T/D EFE N DAN T:O TH ER P AR EN T:)IN STR UCTIO NS F O R Q UALIF IE D D O M ESTIC R ELA TIO NS O RDER (EA RNIN G S A SSIG NM EN T O RDER F O R S U PPO RT)1. DEFINITIONS OF IMPORTANT WORDS IN THE ORDER(a ) A lt e rn ate P aye e: a ny s p ouse , f o rm er s p ouse , c h ild , o r oth er d ependent o f t h e P artic ip ant. (b ) P artic ip an t/O blig or: a ny p ers o n o rd ere d b y a c o urt t o pa y c h ild s u p port, s p ousa l s u p port, o r f a m ily s u pport wh o h as a n a ccru ed b enefit o r a cco unt b ala nce 2 . T A X I N FO RM ATIO N F O R P A YO RS ( c o ntin ued) You s h ould c o nsu lt w it h y o ur p ro fe ssio nal t a x a dvis o r o n t h e specif ic t a x t r e atm ent a nd r e portin g r e quir e m ents a pplic a ble t o dis tr ib utio ns u nder t h is o rd er.(w heth er o r n ot v e ste d) u nder a P la n.(c ) A gent: a ny p ers o n, in clu din g t h e d is tr ic t a tto rn ey o roth er g ove rn m enta l a gency, t o w ho m t h e s u pport is t ob e p aid o n b ehalf o f a n A lt e rn ate P aye e.(d ) P ayo r/P la n : a ny e m plo ye e b enefit p la n d escrib ed inF am ily C ode s e ctio n 8 0 t h at is n ot a g ove rn m enta l p la n as d efin ed in 2 9 U .S .C . § 1 002(3 2). T he t e rm in clu des pla ns b en efit in g s e lf - e m plo ye d in div id uals s u ch a s partn ers a nd s o le p ro prie to rs . I f a n e ntit y o th er t h an t h e Pla n p ays b enefit s t o p artic ip ants u n der t h e P la n, t h e3. OTHER INFORMATION FOR PAYORS This o rd er, w hic h is a n e arn in gs a ssig nm ent o rd er, a nd y o u a s the P ayo r, a re g ove rn ed b y C hapte r 8 , b egin nin g w it h s e ctio n 5200 o f t h e F am ily C ode, a nd r e la te d p ro vis io ns o f t h at C ode and t h e C ode o f C iv il P ro ce dure . Y our a tte ntio n is d ir e cte d partic u la rly t o t h e p ro vis io ns o f C hapte r 8 t h at s e t f o rth y o ur oblig atio ns a s a P ayo r ( re fe rre d t o t h ere in a s t h e ''E m plo ye r'') .te rm P ayo r/P la n a ls o in clu des t h at e ntit y .(e ) Q DRO : a n o rd e r t h at h as b een a ppro ve d b y t h e p la nadm in is tr a to r o f t h e P la n ( o r b y a c o urt o f c o m pete nt juris d ic tio n) a s m ee tin g t h e r e quir e m ents f o r a q ualif ie d dom estic r e la tio ns o rd er u nder 2 9 U .S .C . § 1 056(d ) o r26 U .S .C . § 4 14(p ).(f) A nnuit y : a f o rm o f b enefit in w hic h p erio dic p aym ents( u su ally m onth ly ) a re m ade f o r t h e lif e o f t h e r e cip ie nt and/o r t h e r e cip ie nt's s u rv iv o r. T his o rd er a pplie s t o an nuit ie s a nd t o a ny o th er f o rm o f b enefit p aym ent o r dis tr ib utio n a llo w ab le u nder t h e P la n ( e .g ., s in gle s u m , insta llm ents , a nd o th er p erio dic p aym ents ).W hen b e nefit s u n der t h e P la n a re c u rre ntly p aya ble t o t h e Partic ip ant, w it h h old in g u nder t h is o rd er s h ould c o m mence a s soon a s p ossib le b ut n o la te r t h an 1 0 d ays a fte r y o ur r e ce iv e th e Q ualif ie d D om estic R ela tio ns O rd er f o r S upport. I f b enefit s ar e n o t c u rre ntly p aya ble b ut P artic ip ant h as a pplie d t o r e ce iv e be nefit s , o r a pplie s w it h in 9 0 d ays a fte r y o u r e ce iv e t h is o rd er, or w hile t h e t e m pora ry r e str a in in g o rd er c o nta in ed in it e m 1 3 o f this o rd er is in e ffe ct, t h is o rd er ( in clu din g t h e t e m pora ry re str a in in g o rd er) a pplie s t o t h e b e nefit s P artic ip ant h as a pplie d for a nd b e co m es e ntit le d t o r e ce iv e u nder t h e t e rm s o f t h e Pla n.2. TAX INFORMATION FOR PAYORSOnce t h is o rd er h as b een a ppro ve d a s a Q DRO , a ll b enefit s wit h held p urs u ant t o t h e t e m pora ry r e str a in in g o rd er s h all b e dis b urs e d in a cco rd ance w it h t h e t e rm s o f t h is o rd er o r, t o t h e exte nt t h o se b enefit s a re n ot a ffe cte d b y t h is o rd er, t o t h e pers o n o r p ers o ns e ntit le d t h ere to u nder t h e t e rm s o f t h e P la n.G enera lly s p eakin g, f o r f e dera l in co m e t a x p urp ose s, t h e Partic ip ant w ill b e t a xe d o n a ny c h ild s u pport p aid f r o m a Pla n p urs u ant t o t h is o rd er. A m ounts p aid b y t h e P la n f o r spousa l o r f a m ily s u pport g enera lly w ill b e t a xa ble t o t h e Alt e rn ate P aye e f o r w hose b enefit t h ose a m ounts a re p aid .If y o u h a ve a ny q uestio ns a bout t h is o rd er, p le ase c o nta ct t h e offic e t h a t s e nt t h is f o rm t o y o u a s s h ow n in t h e u pper le ft- h and corn er o f t h e o rd er.4 . I N FO RM ATIO N F O R A LL P A RTIC IP A NTS : Y ou s h ould h ave r e ce iv e d a R equest f o r H earin g R egard in g W age a nd E arn in gsA ssig nm ent ( fo rm 1 299.2 8) w it h t h e Q ualif ie d D om estic R ela tio ns O rd er ( E arn in gs A ssig nm ent O rd er f o r S upport) . I f n ot, y o u may g et o ne f r o m e it h er t h e c o urt c le rk o r t h e d is tr ic t a tto rn ey. I f y o u w ant t h e c o urt t o s to p o r m odif y t h e a ssig nm ent o f y o ur benefit s u nder t h e P la n, y o u m ust f ile ( h and-d eliv e r o r m ail) a n o rig in al c o py o f t h e f o rm w it h t h e c o urt c le rk w it h in 1 0 d ays o f the d ate y o u r e ce iv e d t h is o rd er. K eep a c o py o f t h e f o rm f o r y o ur r e co rd s.If y o u t h in k y o ur s u pport o rd er is w ro ng, y o u c a n a sk f o r a m odif ic a tio n o f t h e o rd er, o r in s o m e c a se s, y o u c a n h ave t h e o rd er set a sid e a nd h ave a n ew o rd er is s u ed. Y ou c a n t a lk t o a ny a tto rn ey o r g et in fo rm atio n f r o m t h e c o urt a bout t h is .Q UALIF IE D D O M ESTIC R ELA TIO NS O RDER F O R S U PPO RT (EA RNIN G S A SSIG NM EN T O RDER F O R S U PPO RT)Pag e f o ur o f f o urele ctr o n ic f o rm  2 002 WWW.LawCA.com La w P ublis h ersFL-460 [Rev. January 1, 2003]