Fill and Sign the Mn Settlement 497312260 Form

STATE OF MINNESOTA DISTRICT COURT COUNTY OF       JUDICIAL DISTRICT FAMILY COURT DIVISION In Re the Marriage of: Court File No. , Petitioner, DOMESTIC RELATIONS ORDER AND , Respondent, WHEREAS, this cause has come to be heard for the purpose of entry of a domestic relations order ("Order") as defined in 29 U.S.C. Section 1056(d)(3) providing for the division and disposition of all or part of the benefits due to (the "Participant") under the PLAN NAME (the "Plan") and granting (the "Alternate Payee") rights in such benefits on the terms set forth in this Order; WHEREAS, this court , 20 , has entered a judgment approving a marital settlement agreement dated , 20 ; due notice having been given; this court having jurisdiction of the parties and the subject matter; and this court being advised in the premises; THEREFORE, THE COURT FINDS AND IT IS HEREBY ORDERED AS FOLLOWS: A. Agreement . On , 20 , this court entered a judgment approving a marital settlement agreement pursuant to a state domestic relations law, which agreement relates to the provision of marital property of the Alternate Payee, who is the spouse of the Participant to which this order applies. B. Participant . The name, date of birth, last known mailing address and telephone - 1 - number of the Participant are: Name: Date of Birth: Address: Phone Number: C. Alternate Payee . The name, date of birth, last known mailing address and telephone number of Alternate Payee are: Name: Date of Birth: Address: Phone Number: D. Change of Address . The Alternate Payee shall keep the Plan Administrator informed of his or her current address and telephone number. Notice of change of name, address, or telephone number shall be made in writing to the Plan Administrator, addressed as follows: (Name) Plan Name (Address) (City, State, Zip) (or to such other address as the administrator may specify in a written notice to the Alternate Payee). E. Transfer of Interest in Pension Plan . The amount of the Participant's benefits to be assigned irrevocably to the Alternate Payee shall be       % of the present value of the accrued benefit under the Plan determined as of , 20       , payable to the Participant at the Participant's age 65. Such present value and benefit conversion shall be determined in accordance with the provisions of the plan and/or the current actuarial assumptions used with respect to the Plan by the Plan actuary. - 2 - The Alternate Payee's benefit shall include all benefits associated with       % of the Participant's salary reductions or employee contributions determined as of , 20       , under the plan. Actuarial calculations performed herein shall be final and binding on the Participant and the Alternate Payee. After the assignment, the participant shall have no remaining rights to the portion assigned. The Alternate Payee shall for all purposes be treated as a beneficiary to whom payment of the assigned portion must be made. The Participant's accrued benefit under the Plan shall be reduced by the       % of the accrued benefit determined as of ,       , to reflect the amount to be paid to the Alternate Payee as determined above. In addition, the Participant's Salary Reduction Account shall be reduced by the total reductions allocated to the Alternate Payee. To the extent that any prior Qualified Domestic Relations Order (within the meaning of Section 414(p) of the Internal Revenue Code of 1986) has awarded amounts to another person which this Order awards to the Alternate Payee, the duplicate amount awarded hereunder shall not be payable. Form of Payment . The form of distribution of the assigned portion shall be in any form permitted in accordance with the Plan other than a joint and survivor annuity with respect to the Alternate Payee and any subsequent spouse. Time of Payment . Payment of any monthly benefits shall be made, or shall commence, at the election of the Alternate Payee, as of the first of any month following the determination by the Plan Administrator that this Order is a qualified domestic relations order, but not earlier that the earliest date the Participant could be eligible to receive or begin receiving benefits under the Plan. If the Alternate Payee receives or begins to receive monthly payments prior to the Participant's normal retirement age, but before the Participant commences his or her benefit, the benefit that would otherwise be payable to the Alternate Payee at the Participant's normal retirement age shall be actuarially reduced in accordance with the Plan's definition of actuarial equivalence for - 3 - this purpose, disregarding any employer subsidies for early retirement. If the Alternate Payee receives or begins to receive monthly payments prior to the Participant's normal retirement age, but on or after the date the Participant commences his or her benefit, the benefit that would otherwise be payable to the Alternate Payee at the Participant's normal retirement age shall be reduced in accordance with the Plan's early retirement provisions. F. Death . (1) Alternate Payee . If the Alternate Payee dies before distribution begins under the Order, the amounts payable under this Order shall be forfeited except that the Alternate Payee's share (if any) of the Participant's Salary Reduction Account or employee contributions plus interest thereon, if any, shall be paid to the Alternate Payee's estate. If the Alternate Payee dies after distributions have begun under this Order, benefits shall continue only if, and only to the extent, required by the form of distribution elected by the Alternate Payee. In the event the Alternate Payee has elected a form of payment which does not require continuation of benefit payments to a designated beneficiary, and has not received benefit in excess of the salary reduction plus interest or employee contributions (if any) due to the Alternate Payee, the excess of such salary reductions or employee contributions plus interest (if any) over the benefit received by the Alternate Payee shall be payable to the Alternate Payee's estate. In no event shall the death of the Alternate Payee, either before or after distributions have begun under this Order, result in any increase of benefits to the Participant. *(2) Participant . Upon the death of the Participant, whether before or after distributions have begun under this Order, the Alternate Payee shall not be entitled to any benefits under the Plan in addition to the benefits to which the Alternate Payee is entitled under Section E. - 4 - *{THIS PROVISION IS OPTIONAL--LAW PERMITS ALTERNATE PAYEE TO BE DESIGNATED AS SURVIVING SPOUSE WITH RESPECT TO PARTICIPANT'S BENEFIT.} G. Required Documentation . The Alternate Payee shall provide such written requests for payment, consents to payment, or receipts of payment as the Plan Administrator may require. If such documents are not provided to the Plan within two months after the Alternate Payee is requested to provide them, all of the Alternate Payee's remaining rights under the Plan shall be forfeited, except as may be otherwise provided pursuant to Section K. H. Limitations on Order . Nothing in this Order shall require the Plan to provide-- 1. any type or form of benefit or any option not otherwise provided under the Plan; 2. any increased benefits (determined on the basis of actuarial value); or 3. the payment of any benefits to the Alternate Payee which are required to be paid to another Alternate Payee under an Order previously determined to be a Qualified Domestic Relations Order. I. Modification of Order . The Plan Administrator and the Alternate Payee may modify (by written agreement) any provision of this Order without further court approval so long as the change has no adverse effect on the Participant. The Plan Administrator may unilaterally modify any term of this Order to the extent necessary to comply with applicable law. J. Interpretation of Order . In case of conflict between the Order and the terms of the Plan, the terms of the Plan shall prevail. K. Termination of Plan . If the Plan is terminated and all benefits are distributed, amounts due under this Order shall be immediately distributable. L. Notices . All notices to be given or documents to be sent to the Plan Administrator shall be addressed in accordance with Section D and shall not be deemed given to the Plan unless - 5 - sent by certified mail, return receipt requested. M. Indemnification . The Alternate Payee and the Participant shall hold the Plan (and its sponsor and fiduciaries) harmless from any liabilities which arise from following this Order, including any reasonable attorney's fees which may be incurred in connection with any claims which are asserted because the Plan honors this Order. N. Attorney's Fees . The Plan and its sponsor and fiduciaries shall not be responsible for any attorneys' fees incurred by the Participant of the Alternate Payee in connection with the obtaining or enforcement of this Order. O. QDRO Status . The parties intend that this Order will qualify as a Qualified Domestic Relations Order pursuant to Section 414 (p) of the Internal Revenue Code of 1986 and that it shall be interpreted and administered in conformity with that Section. P. Court's Jurisdiction to Modify . The Court retains jurisdiction to establish or maintain this Order as a Qualified Domestic Relations Order and to modify the Order, subject to the limitations of Section I. So Stipulated: ________________________________ Participant ________________________________ Alternate Payee Enter:___________________________ Date: ________________. - 6 -