This Model Form is Governed by
Texas Government Code Annotated Chapter 804
and the Rules of the Employees Retirement System of Texas
Title 34, Part IV
Texas Administrative Code
Chapter 74.1-11
QUALIFIED DOMESTIC RELATIONS ORDER
This order is intended to meet the requirements for a “qualied domestic relations order” relating to the EMPLOYEES
RETIREMENT SYSTEM OF TEXAS, hereinafter called the “Plan.” This Order is an integral part of the Decree of
Divorce granted on . In compliance with those requirements, the following is specied:
1. This Order assigns a portion of the benets payable under the Plan to
in recognition of marital rights in ’s benets payable
under the Plan.
2. Participant in the Plan is , whose last known mailing address
is , whose birth date
is , and whose Social Security Number is .
3. Alternate Payee is , whose last known mailing address is
, whose birth date
is , and whose Social Security Number is . Participant
and Alternate Payee became married on .
4. As part of a just and right division of the estate of the parties, Alternate Payee is hereby awarded a portion of any
benets payable with respect to Participant which Participant, or Participant’s designated beneciary, surviving
spouse, or estate may become entitled to receive from the Plan, by way of a return of accumulated contributions
or by way of any annuity that may become payable as a result of Participant’s participation in the Plan, such
portion to be determined by:
multiplying
by a fraction, the numerator of which is the amount of credited service with the Plan earned by Participant
between and , and the denominator of which
is the amount of credited service by Participant under the Plan on , and
then multiplying that product by the value of the benet that would be payable to Participant or Participant’s
designated beneciary, surviving spouse or estate by the Plan, as if the Participant were eligible to receive
such benet on .
§
§
§
§
§
§
§
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date divorce granted
name of alternate payee
his/her
name of participant
name of participant
participant’s address
birth date
social security number
alternate payee’s address
alternate payee birth date
alternate payee SSN
date of marriage
date of marriage
one-half, or other proportionate share of the community property interest
the date the divorce was granted
the date the divorce was granted
the date the divorce was granted
5. The award to Alternate Payee under paragraph 4 of this Order is expressly made subject to the following
provisions:
(a) This Order shall not be interpreted in any way to require the Plan to provide any type or form of benet or
any option not otherwise provided under the Plan.
(b) This Order shall not be interpreted in any way to require the Plan to provide increased benets determined
on the basis of actuarial value.
(c) This Order shall not be interpreted in any way to require the Plan to pay any benets to an Alternate Payee
named in this Order which are required to be paid to another alternate payee under another order previously
determined to be a qualied domestic relations order.
(d) This Order shall not be interpreted in any way to require the payment of benets to the Alternate Payee
before the retirement of the Participant, the distribution of a withdrawal of contributions to the Participant
as authorized by the statutes governing the Plan, or other distribution to the Participant required by law.
(e) This Order shall be interpreted to require that, in the event of Participant’s retirement before normal
retirement age, the benets payable to Alternate Payee shall be reduced in a proportionate amount.
(f) This Order shall not be interpreted to require the designation of a particular person as the recipient of
benets in the event of the Participant’s death, or to require the selection of a particular benet payment
plan or option.
(g) Applicable Texas laws and rules do not currently permit alternate payees to receive any future benet
increases. In the event that, after the date the divorce was granted, the Texas Legislature provides or
requires any benet increase specically for alternate payees of the Plan, Alternate Payee shall receive
a proportionate part of such increase or such other amount as directed by the Texas Legislature, unless
such an increase would disqualify this Order as a qualied domestic relations order under applicable law
or unless such increase would otherwise conict with the rules of the Plan.
(h) In the event that, after the date of divorce was granted, the amount of any benet otherwise payable to
Participant is reduced by law, the portion of benets payable to Alternate Payee shall be reduced in a
proportionate amount.
(i) If, as a result of Participant’s death after the date the divorce was granted, a payment is made by the Plan
to Participant’s estate, surviving spouse, or designated beneciaries, which payment does not relate in any
way to Participant’s length of employment or accumulated contributions with the Plan, but is purely a death
benet as a result of employment or retired status at the time of death, no portion of such payment
is community property, and Alternate Payee shall have no interest in such death benet.
(j) In lieu of paying Alternate Payee the interest awarded by this Order, the Plan may pay the Alternate Payee
an amount that is the actuarial equivalent of that interest in the form of (1) an annuity payable in equal
monthly installments for the life of the Alternate Payee, or (2) a lump sum.
(k) All payments to Alternate Payee under this Order shall terminate upon Alternate Payee’s death or at such
earlier date as may be required as a result of the retirement option selected by Participant.
6. All benets payable under the Plan other than those payable under paragraph 4, above, to Alternate Payee shall
be payable to Participant in such manner and form as Participant may elect in sole and undivided
discretion, subject only to Plan requirements.
7. Alternate Payee is ORDERED to report any retirement payments received on any applicable income tax return,
and to promptly notify the Plan of any changes in Alternate Payee’s mailing address. The Plan is authorized
to issue a Form 1099R or other form required by the Internal Revenue Service on any direct payment made to
Alternate Payee.
8. Participant is designated a constructive trustee for receiving any retirement benets under the Plan that are due
to Alternate Payee but paid to Participant. Participant is ORDERED to pay the benet dened in this paragraph
directly to Alternate Payee within three (3) days after receipt by Participant. All payments made directly to
Alternate Payee by the Plan shall be a credit against funds required to be paid by this Order.
9. The Court retains jurisdiction to amend this Order so that it will constitute a qualied domestic relations order
under the Plan even though all other matters incident to this action or proceeding have been fully and nally
adjudicated.
SIGNED this day of , 20 .
JUDGE PRESIDING
APPROVED:
Participant (Participant’s Counsel, if applicable)
Alternate Payee (Alternate Payee’s Counsel, if applicable)
his/her