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Qualified Domestic Relations Order - QDRO

STIPULATED QUALIFIED DOMESTIC RELATIONS ORDER - QDRO
RE: ACCOUNT OF [NAME]

This matter having come before the Court upon the stipulation of the
parties hereto; Petitioner being represented by [Attorney]; Respondent
being represented by [Attorney]; the Court being fully advised herein,
HEREBY FINDS, AND IT IS THEREFORE ORDERED, ADJUDGED AND DECREED:

The undersigned parties stipulate that the parties shall be bound by
the following Order:

A. IDENTITY OF RETIREMENT PLANS: The (NAME OF PLAN) retirement plan
covered by this Order is:

1. The (NAME OF PLAN) account number:[Number] in the name of [Name].

B. INTENT, PURPOSE AND NOTICES:

1. [Name of Owner/Participant], Owner/Participant and [Name],
Co-owner/Alternate Payee and former spouse of [Name], intend herein to
divide and allocate their community property interest in the
applicable account.

2. This Order is made pursuant to the marital property laws of the
State of [State].

3. All notices, including notices of motion in this proceeding shall
be deemed sufficient only if delivered personally or given by mail,
postage prepaid, addressed to the last known address of the
appropriate person.

4. Social Security Numbers, dates of birth for the Owner/Participant,
[Name] and the Co-owner/Alternate Payee, [Name], and current addresses
for all named parties, are set forth herein. These addresses shall
continue to be correct for the purposes of notification, unless the
party to whom notice is to be given has notified the others of a
change of address. Also set forth herein is the date of marriage and
date of separation or divorce.

OWNER:
Name:
Address:
Social Security Number:
Date of Birth:
CO-OWNER:
Name:
Address:
Social Security Number:
Date of Birth:
Date of Marriage:
Date of Divorce:

5. The (NAME OF COMPANY) maintains the (NAME OF PLAN) account of .

C. DETERMINING THE COMMUNITY PROPERTY INTEREST IN THE PENSION PLAN

1. The Owner/Participant has made certain deposits to the account
which are the community property of the Owner/Participant and the
Co-owner/Alternate Payee. The parties' total community and marital
property interest in Owner's/Participant's (TYPE OF ACCOUNT) account
is a ratio of the number of months married divided by the total number
of months of service. Petitioner is entitled to one-half of the
community property benefit acquired up to and including (DATE OF
DIVORCE).

The Co-owner/Alternate Payee is hereby awarded one-half of the
community interest in (TYPE OF) account as her/his sole and separate
property. Co-owner's/Alternate Payee's one-half share of the account
proceeds shall be transferred to Co-owner/Alternate Payee [Name]'s
(NAME OF ACCOUNT AND NUMBER FOR TRANSFER, IF ANY). This transfer is
deemed a transfer to [Name] of her one-half interest in (TYPE OF)
account.

D. GENERAL PROVISIONS

1. This Order does not require (NAME OF COMPANY) to provide:
Any type or form of benefit, or any benefit option, not otherwise provided under
(NAME OF COMPANY) contractual obligations owed
Owner/Participant and Co-owner/Alternate Payee; Increased account
value; Benefits to the Co-owner/Alternate Payee which are required to
be paid to another Co-owner/Alternate Payee under another Order
previously determined to be a QDRO

2. Each party will, upon receiving a reasonable request, perform any
act reasonably necessary to carry into effect the terms of this Order.

3. Each party will be responsible for, and will pay, any taxes that
are due on account of any amount received by that party from (NAME OF
PLAN) account.

4. The Court retains jurisdiction to make further Orders as are
necessary to enforce or clarify the provisions of this Order.

5. Claims for benefits and beneficiary designations must be made on
forms provided by (NAME OF COMPANY).

Date:_______________________ _________________________________________
Owner's Signature

Date:_______________________ _________________________________________
Owner's Attorney's Signature

Date:_______________________ _________________________________________
Co-owner's Signature

Date:_______________________ _________________________________________
Co-owner's Attorney's Signature

IT IS SO ORDERED:

Date:_______________________ _________________________________________
DISTRICT COURT JUDGE


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