Fill and Sign the Qualified Domestic Order Form

NO. ___________ IN THE MATTER OF ) THE MARRIAGE OF ) ) _________________________ ) AND ) _________________________ ) ) AND IN THE INTEREST OF ) _________________________ , ) A MINOR CHILD ) QUALIFIED DOMESTIC RELATIONS ORDER This Order is an integral part of the Decree of Divorce signed in this case on _____________ , _______ . This Order is entered pursuant to Sec. 3.633 and Sec. 5.01 of the Texas Family Code, and is intended to serve as a Qualified Domestic Relations Order ("Order") by which a division and disposition of the Respondent's benefit under the plan specified below shall be and is -made according to the provisions of Sections 401(a)(13) and 414(p) of the Internal Revenue Code of 1986, as amended ("IRC"). IT IS ORDERED AND ADJUDGED as follows: A. STATEMENT OF FACTS 1. The plan ("Plan") to which this Order applies is the ____________________ , and the Plan Administrator is the Benefits Committee of the _______________ . 2. The Respondent, ________________ , whose Social Security Number is __________ , and whose last known address is __________________ , ________ , Texas ______ , is the Participant. 3. The Petitioner, ____________________________ , whose Social Security Number is _____________ , and whose last known address is ____________________ , _________ , Texas _________ , is the Alternate Payee and the former spouse of the Participant. 4. The division and disposition of the Participant's benefit under the Plan pertains to the equitable distribution of marital property rights. B. PROVISIONS REGARDING PAYMENT TO THE ALTERNATE PAYEE 1. It is the intention of the parties and the ORDER of this Court that the Alternate Payee receive a benefit from the Plan of $ _________ , unadjusted for any allocable gains or losses. 2. Benefits to the Alternate Payee shall be distributed in accordance with a form of payment elected by the Alternate Payee and provided under the Plan to the Participant (other than in the form of a joint and survivor annuity with respect to the Alternate Payee and her subsequent spouse). The Alternate Payee has the right to elect to commence distribution under t-he Plan at any time after the Plan Administrator has deter-mined that the Order is a Qualified Domestic Relations Order within the meaning of Internal Revenue Code Section 414(p) and after the Alternate Payee has filed a proper distribution election form wit-h the Plan Administrator. Unless the Alternate Payee elects an earlier distribution date (on a form provided by the Plan Administrator), distribution to the Alternate Payee will commence -when the Participant begins to receive distribution under the Plan following his separation from service. Except as otherwise provided under the Plan for involuntary distributions of account balances with values of $ ________ . or less, distribution to the Alternate Payee shall be made in accordance with the terms of this paragraph 2 and after the Alternate Payee has filed a proper distribution election form with the Plan Administrator. 3. If the Plan provides a choice of investment options to participants and distribution to the Alternate Payee is deferred,the Alternate Payee may elect -on the appropriate form provided by the Plan Administrator the -manner in which her interest under the Plan is to be invested. The investment options available to the Alternate Payee shall be the same investment options available to the Participant under the Plan. 4. In the event the Alternate Payee dies before her entire interest under the Plan has been distributed, the remaining portion of such interest shall be distributed in a single lump sum to the beneficiary designated by the Alternate Payee on a form provided by the Plan Administrator -and filed by the Alternate Payee with the Plan Administrator, or if there is no such designated beneficiary then living, to the Alternate Payee's estate. C. TAX CONSIDERATIONS The Alternate Payee shall include all of the taxable portion of benefits received from the Plan in her gross income for the taxable year of receipt. For purposes of IRC Section 402(a)(9), the Alternate Payee shall be treated as the distributee of the distribution of payments made to her under this Order. Said benefits, when paid, will not be taxable income or a deduction on the Participant's income tax return. The balance to the credit of the Participant shall not include any amount paid or payable to the Alternate Payee under this Order. Further, the Participants s investment in the Plan (cost basis), if any, shall be shared proportionately by him and the Alternate Payee as provided in IRC Section 72(m) (10). D. GENERAL PROVISIONS 1. Pursuant to IRC Section 414(p)(3), this Order: (a) Does not require the Plan to provide any type or form of benefit, or any option, not otherwise provided under the Plan; (b) Does not require the Plan to provide increased benefits (determined on the basis of actuarial value); and (c) Does not require the payment of benefits to the Alternate Payee which are required to be paid to another alternate payee under another order previously determined to be a Qualified Domestic Relations Order. 2. If the Plan terminates prior to full distribution to the Alternate Payee of her interest in the Plan, such interest shall be distributed according to the provisions of the Plan governing distributions in the event of plan termination. 3. It is intended that this Order qualify as a Qualified Domestic Relations Order under the Retirement Equity Act of 1984, as amended, and the provisions hereof be interpreted and administered in conformity with such act. 4. The Court retains jurisdiction to amend this Order for purposes of establishing and maintaining its qualification as a Qualified Domestic Relations Order under the Retirement Equity Act of 1984, as amended. SIGNED AND ENTERED on ______________ , ______ . ________________________________ JUDGE PRESIDING APPROVED AND CONSENTED TO AS TO BOTH FORM AND SUBSTANCE: ________________________________ __________________ , Petitioner _________________________________ __________________ , Respondent