QDRO A

        NOW ON THIS _______[date]________ , the above-entitled matter came on upon the 

application of the parties for a Qualified Domestic Relations Order under the Internal Revenue 

Code and the Kansas Public Employees Retirement System Act. The Court having examined 

and considered the pleadings filed herein, and being well and fully advised in the premises, finds 

the following facts and issues the following orders: 

1.       Plan Participant / Alternate Payee. The Court finds (a) that ____________________ is 

a "Plan Participant" or "Participant" of the Kansas Public Employees Retirement System [or the 

Kansas Police and Firemen's Retirement System / or the Retirement System for Judges] (the 

"Plan"); (b) that pursuant to K.S.A. 74-4923(b) [or K.S.A. 20-2618 for Judges], the Plan 

Participant's accrued benefits under the Plan are subject to this Qualified Domestic Relations 

Order; (c) that ___________________ is an "Alternate Payee" under this order; and (d) that 

____________________ shall be the Date of Division, from and after which the Alternate 

Payee's award under this order shall accrue interest in the same manner and at the same rate as 

interest is credited to the Plan Participant's Accumulated Contributions Account ("Account"). 

2.       Plan Participant's Name and Mailing Address: The name, last known mailing 

address and Social Security Number of the Plan Participant is as follows:

_______________________________

_______________________________

_______________________________

Social Security Number __________________

and Social Security Number of the Alternate Payee is as follows:

_______________________________

_______________________________

_______________________________

Social Security Number __________________

their respective current mailing addresses and / or current instructions as to automatic deposit of 

funds. The parties are directed to timely submit to the administrator of the Plan all documents 

that are required to implement this order. The Plan Administrator is the Kansas Public 

Employees Retirement System, 611 S. Kansas, Suite 100, Topeka, KS 66603-3803.

5.       Determination of Amount Awarded to Alternate Payee. Upon the Plan Participant's 

eligibility and request to retire or withdraw funds from the Plan, or upon the Plan Participant's 

death, the Plan shall set aside and pay to Alternate Payee the following from the Plan 

Participant's Account: [Note: Here state either a specific dollar amount or a specific percentage 

of the Account to be paid to the Alternate Payee from the Account.]

6.       Accrual of Interest on Alternate Payee's Marital Portion. From and after the Date of 

Division, the Alternate Payee's marital portion of the Account shall accrue interest at the same 

rate and in the same manner as interest is credited to the Participant's portion of the Account 

until distribution shall occur.

7.       Accrual of Interest on Participant's Account. All contributions to the Participant's 

Account made after the the Date of Division shall accrue solely to the Participant's portion of the 

Account, together with interest thereon, until the event of distribution.

8.       Limitations on Order. Nothing in this Order shall require, and this Order shall not be 

construed to require: (a) the Plan to provide any type or form of benefit or any option not 

otherwise provided under the Plan; or (b) the Plan to provide increased benefits (determined on 

the basis of actuarial value) to the alternate payee; or (c) the Plan to pay benefits to the Alternate 

Payee which are required to be paid to another Alternate Payee under another Order previously 

determined to be a Qualified Domestic Relations Order. 

9.       Retention of Jurisdiction. The Court shall retain jurisdiction over the allocation and 

transfer to the Alternate Payee of the marital portion of Participant's benefits or Account balance 

as the case may be, and to issue further Orders as needed to enforce this Order.