• Retirement Benefits Court Order Processing Request Form

    Use this form to request processing of a court order affecting retirement benefits and provide the documents and details needed to review the request.

  • Requester and Participant Information

  • Format: (000) 000-0000.
  • Participant Date of Birth*
     - -

  • Court Order and Case Details

  • Court Order Date*
     - -
  • Order Effective Date*
     - -
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  • Order Status*

  • Retirement Benefit Plan and Processing Request

  • Retirement plan or benefit type affected*
  • Current beneficiary status
  • Preferred effective processing date
     - -

  • Supporting Documents and Instructions

  • Attached Supporting Documents*
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  • Should be Empty:
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