Fillable Tennessee Consolidated Retirement System (State of Tennessee)

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Tennessee Consolidated Retirement System (State of Tennessee)

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TR-0466 Revised 11/18/19 Page 1 RDA-413
_________________________ COURT
_________________________ COUNTY, TENNESSEE
CASE NO. ____________________
________________________________________ VS. ________________________________________
Plaintiff Defendant
QUALIFIED DOMESTIC RELATIONS ORDER
order” relating to
the Tennessee Consolidated Retirement System, hereinafter referred to as the “Retirement System”. This
Order relates to the provision of marital property rights and is an integral part of the divor
______________________.
(Month/Day/Year)

1. 

Regulations.
 

(Name of Alternate Payee) (Name of Member)

 
(Name of Member)
__________________________________________________________________________________________________________________
(Street Address)
__________________________________________________________________________________________________________________
(City) (State) (Zip Code)

000
00
0000
OR
*
Tennessee Consolidated Retirement System
502 Deaderick Street
Nashville, Tennessee 37243-0201
(800) 922-7772
treasury.tn.gov/tcrs
TR-0466 Revised 11/18/19 Page 2 RDA-413
4. 
(Name of Alternate Payee)
__________________________________________________________________________________________________________________
(Street Address)
__________________________________________________________________________________________________________________
(City) (State) (Zip Code)

000
00
0000
OR
*
5. The date of the marriage is ______________________.
(Month/Day/Year)
 
(Month/Day/Year)
 
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

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* 
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
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
* 

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
 
the Alternate Payee $__________________ OR
period of marriage provided in this Order. (designate only one option)
9. 


TR-0466 Revised 11/18/19 Page 3 RDA-413
 The 


 

 
 

 
 
 
 
 
 

 

under this Order.

____________________________________________________
Judge’s Signature
____________________________________________________
Judge’s Printed Name
____________________________________________________
Court

____________________________________________________ ____________________________________________________
Member’s Signature Member’s Counsel - Signature
____________________________________________________ ____________________________________________________
Alternate Payee’s Signature Alternate Payee’s Counsel - Signature
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
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click to sign
signature
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signature
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TR-0466 Revised 11/18/19 Page 4 RDA-413
CERTIFICATION OF SERVICE



 ________________________________________________  ________________________________________________
 _____________________________________________  _____________________________________________
 ______________________________________  ______________________________________
________________________________________________________
(Clerk’s Certification Seal) Clerk’s Signature
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Tennessee Consolidated Retirement System (State of Tennessee)

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Completed 27 January 2021

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