Qualified Domestic Relations Order /
Return these forms to:
MEBT Service Center
5446 California Ave. SW
Suite 200
Seattle, WA 98136
Fax: 206-938-5987
The following documents are included in this package:
· Information Sheet for Preparing Qualified Domestic Relations Orders
· Waiver of Hold Due to Notice of Potential Domestic Relations Order
· Sample Qualified Domestic Relations Order
Additional information
If you have any questions regarding the information provided in this package, please contact the MEBT Service Center at 1-877-690-5410.
Please refer to the MEBT Summary Plan Description document for additional plan information available online at www.mebt.org.
INFORMATION SHEET FOR PREPARING
QUALIFIED DOMESTIC RELATIONS ORDERS
The Plan specifically permits benefits to be divided and distributed according to a qualified domestic relations order (QDRO). The Plan permits a QDRO to provide for an immediate distribution to the alternate payee even though the participant is still employed by the City. A Participant or alternate payee contemplating a division of benefits in the form of a QDRO should have a copy of the Plan's QDRO procedures and the applicable Plan section on QDROs.
The Plan Committee encourages you to inquire early if a domestic relations order ("DRO") is being drafted. The Plan Committee and its counsel will work with counsel for the participant and alternate payee to pre-approve DROs and minimize costs. The record-keeping fees to process the DRO, as well as the legal fees to review the DRO, are borne by the participant (and or his/her alternate payee if specified in the DRO). Careful attention to the Plan Procedures will minimize the fees to process and approve a QDRO.
All DROs presented to the Plan Committee should contain the following:
· The order is entered pursuant to a state domestic relations law;
· The order relates to providing child support, alimony (maintenance) payments or marital property rights;
· Identify the Participant and Alternate Payee's name, address, Social Security Number and date of birth;
· Identify the Plan: The City of Edmonds Employees' Retirement Benefit Plan;
· Identify the dollar amount or percentage of the participant's benefit the Plan must pay the alternate payee (it will come pro rata from each account);
· Describe the form of benefit payment and timing, which must be consistent with the Plan (the plan allows an immediate distribution to an Alternate Payee);
· Identify the date the segregation should be effective and whether the amount is subject to earnings and losses from that date until later distributed (The Plan values accounts monthly, (1/31, 2/28, 3/31, etc.). Use of such a date in a QDRO will reduce administrative fees charged to the participant/alternate payee's account.); and
· Describe how the administrative and legal fees should be allocated to the participant and/or alternate payee.
WAIVER OF HOLD DUE TO NOTICE OF POTENTIAL
DOMESTIC RELATIONS ORDER
TO: City of Edmonds Employees' Retirement Benefit Plan Committee
We, ______, Participant, and ______, spouse (alternate payee), have been provided a copy of the Plan's QDRO Procedures which place a temporary hold upon a Participant's accounts when it has written or verbal notice of a potential domestic relations order. We understand that the Plan suspends the Participant's right to take withdrawals under ArticleVI and may suspend any distributions to the extent the Plan Committee deems necessary. By our signatures below, we agree to waive the hold on the accounts pursuant to the procedures and consent to any withdrawal or distribution permitted under the Plan.
We, the undersigned, agree that the above is true and correct and the execution of this waiver election is both voluntary and knowing of the consequences.
Date: /Participant
Print Name
SPOUSAL CONSENT
The undersigned, being the spouse of the Participant who has signed this Waiver, hereby consents to the waiver of the hold on accounts pursuant to the QDRO Procedures and consents to any withdrawal or distribution permitted under the Plan to the Participant. I certify that I understand the terms of the hold on accounts described in the copy of QDRO Procedures provided to me by the Plan Committee, my right not to consent to this Waiver Election and that the waiver of the hold may permit a distribution which may reduce the amount, if any, for which I may be eligible pursuant to a qualified domestic relations order.
I have executed this consent this ____ day of ______, 20___.
Date
Participant's Spouse
Print Name
STATE OF WASHINGTON)
: ss.
COUNTY OF KING )
I certify that I know or have satisfactory evidence that ______is the person who appeared before me, and said person acknowledged that he/she signed this instrument and acknowledged it to be his/her free and voluntary act for the uses and purposes mentioned in this instrument.
Dated: ______
Notary Public in and for the State of Washington
Residing at
My appointment expires:
DISCLAIMER: THIS IS A SAMPLE QUALIFIED DOMESTIC RELATIONS ORDER (QDRO) ONLY. IT SHOULD NOT BE EXECUTED WITHOUT INDEPENDENT REVIEW BY LEGAL COUNSEL FOR BOTH THE PARTICIPANT AND ALTERNATE PAYEE. IT SHOULD NOT BE USED WITHOUT REVIEWING THE ISSUES WITH RESPECT TO THE PLAN INVOLVED OR THE PARTICULAR CIRCUMSTANCES OF YOUR CLIENT. IT IS SUITABLE FOR USE WITH MEBT PLANS. IT ASSUMES THE PLAN IS NOT SUBJECT TO ERISA AND THE ALTERNATE PAYEE DESIRES AN IMMEDIATE DISTRIBUTION. THE PLAN MAKES NO REPRESENTATIONS AS TO THE SUITABILITY OF THIS FORM TO YOUR OR YOUR CLIENT’S PARTICULAR NEEDS. NOTHING IN THIS DOCUMENT IS INTENDED TO BE CONSTRUED AS THE PROVISION OF LEGAL ADVICE TO EITHER THE PARTICIPANT OR THE ALTERNATE PAYEE.
IN THE SUPERIOR COURT FOR THE STATE OF WASHINGTON
FOR COUNTY
In re the Marriage of: )
)
, ) No
)
Petitioner, ) QUALIFIED DOMESTIC
) RELATIONS ORDER
and )
)
, )
)
Respondent, )
)
THIS MATTER, has come before the undersigned Judge/Court Commissioner of the above entitled court; the Petitioner , being represented by his/her attorney , and the Respondent , being represented by his/her attorney , and the parties having stipulated and agreed to the provisions of this Order. The Court entered a Decree of Dissolution on . It is ORDERED as follows:
1. The parties and the Court intend this Order to be a Qualified Domestic Relations Order (“QDRO”) within the meaning of Section414(p) of the Internal Revenue Code of 1986, as amended (“Code”). This Order is entered pursuant to the laws of the State of Washington governing the division of marital property between spouses in a dissolution of marriage action.
2. This Order creates and recognizes the existence of the Alternative Payee’s right to receive a portion of the benefits payable with respect to the Participant.
FACTS
3. This QDRO applies to the City of Edmonds Employees’ Benefit Plan (“Plan”). This Order does not apply to benefits under any other plan under the name of the Participant not specifically transferred by this Order. ______is a participant in the Plan. ______is the Alternate Payee for purposes of this QDRO. The Alternate Payee is the former spouse of the Participant.
4. The Participant’s name, Social Security Number, date of birth and mailing address are:
Mailing Address:
SSN:
Date of Birth:
5. The Alternate Payee’s name, Social Security Number, date of birth and mailing address are:
Mailing Address:
SSN:
Date of Birth:
The Alternate Payee shall keep the Plan Committee informed of his/her current address. Notice of any change of address shall be made, in writing, to the Plan Committee, addressed as follows (or to such other address as may be designated by the Plan Committee by written notice mailed to the above address of the Alternate Payee):
MEBT Plan Committee
MEBT Service Center
5446 California Ave. SW, Suite 200
Seattle WA 98136
6. The portion of the Participant’s Plan benefits payable to the Alternate Payee under this QDRO is ______Dollars ($______) [or ______(_____%)][Use a percentage or a dollar amount, but not both] of assets credited to Participant’s account segregated as of the date ______, [plus earnings and losses to the date of distribution] [If the Amount is a lump sum with no earnings or losses, then state “without any earnings or losses regardless of when the amount is distributed”] to the Alternate Payee. The balance of the assets credited to the Participant’s account shall remain the Participant’s.
[Use any business date if the segregation date is after December 31, 2002. If the segregation date is before January 1, 2003 and after December 31, 2000, use the last day of any month and use the last day of each quarter if the segregation date is before January1,2001.]
TIME AND MANNER OF PAYMENT
7. The Plan shall pay the amount designated in Paragraph 6 of this QDRO to the Alternate Payee. The Plan shall pay this amount as soon as administratively feasible or at the election of the Alternate payee. The Alternate Payee shall complete and provide the Plan Committee the necessary election forms to process a distribution.
8. This QDRO does not require the Alternate Payee’s consent to the distribution from the Plan, and the Plan may distribute the amount described in Paragraph 6 without obtaining any further consent from the Alternate Payee. However, the Alternate Payee agrees to execute such reasonable and necessary election forms, in writing, as may be required by the Plan Committee of the Plan to meet uniformly applied distribution procedures administered by the Plan, including, without limitation, federal income tax withholding elections, distribution instructions, receipts, consents, etc.
9. After segregation or payment of the amount required by this QDRO, the Alternate Payee shall have no further claim against the Participant’s interest in the Plan and the Alternate Payee shall not be treated as a spouse or surviving spouse for purposes of any election, waiver or consent procedure under the Plan.
10. The Plan specifically permits the Alternate Payee to elect to receive a lump sum payment of benefits as described in this Order as of any Plan distribution date even though the Participant has not separated from his/her employment.
11. Until the Plan completes payment of all benefits pursuant to this QDRO, the Plan shall treat the Alternate Payee as a surviving spouse for purposes of any distribution under the Plan, but the Alternate Payee shall receive, as surviving spouse, only the amount described in Paragraph 6 of this QDRO. The sole purpose of this Paragraph 11 is to ensure payment to the Alternate Payee in case of the Participant’s death prior to payment by the Plan of the amount described in Paragraph 6 of this QDRO.
12. In the case of the Alternate Payee’s death prior to the payment by the Plan of all benefits under this QDRO the Plan shall pay the remaining benefits under this QDRO to the Alternate Payee’s beneficiary as the Alternate Payee. The Alternate Payee may file a written beneficiary designation with the Plan Committee. If the Alternate Payee fails to file a written beneficiary designation with the Plan Committee, the Plan shall treat the Alternate Payee’s estate as the Alternate Payee’s beneficiary.
13. The Alternate Payee assumes sole responsibility for the tax consequences of the distribution under this QDRO.
14. The administrative and legal fees associated with determining the qualification of and administering this Order shall be split equally between the parties. [You may choose another method of allocating these costs so long as the method is clearly defined.]
CODE § 414(p)(3) PROVISIONS
15. This QDRO does not require the Plan to provide any type or form of benefit the Plan does not otherwise provide. In addition, this Order does not require payment at a time that is not permitted under the Plan.
16. This QDRO does not require the Plan to provide increased benefits.
17. This QDRO does not require the Plan to pay any benefits which another order previously determined to be a qualified domestic relations order requires the Plan to pay to another alternate payee.
PROCEDURE FOR PROCESSING THIS QDRO
18. The Plan shall treat this QDRO in accordance with Code § 414(p)(7). While the Plan is determining whether this Order is a Qualified Domestic Relations Order, the Plan Committee shall separately account for the amounts which would have been payable to the Alternate Payee while the Plan is determining the qualified status of this QDRO.
19. The Plan Committee promptly shall notify the Participant and the Alternate Payee of the receipt of this QDRO and shall notify the Participant and the Alternate Payee of the Plan’s procedures for determining the qualified status of this QDRO. The Plan Committee shall determine the qualified status of the QDRO and shall notify the Participant and the Alternate Payee of the determination within a reasonable period of time after receiving this QDRO.
JURISDICTION RETAINED
This Court retains jurisdiction over this matter as provided by law.
DONE IN OPEN COURT this ______day of______, ______.
______
JUDGE/COURT COMMISSIONER
Presented by:
______, WSBA#______
Attorney for Petitioner/Participant
Approved as to Form;
Notice of Presentation Waived
______, WSBA# ______
Attorney for Respondent/Alternate Payee