(TYPE "C" -- Plan Participant Already Retired, Splits Current/Ongoing Benefit Payments)
QUALIFIED DOMESTIC RELATIONS ORDER
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" 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
the Plan Participant is retired from the Plan and is receiving a monthly retirement benefit from
the Plan; (c) that pursuant to K.S.A. 74-4923(b) [or K.S.A. 20-2618 for Judges], the Plan
Participant's monthly retirement benefit under the plan is subject to this Qualified Domestic
Relations Order; and (d) that ___________________ is an "Alternate Payee" under this order.
2. Marital Period / Marital Share / Amount Awarded to Alternate Payee. The Alternate
Payee shall receive from the Plan a _____ percent (____%) share of the Plan Participant's
monthly benefits from the Plan [or the Alternate Payee shall receive $________ per month from
the Plan as her share of the Plan Participant's monthly benefits from the Plan].
3. Plan Participant's Name and Mailing Address: The name, last known mailing address
and Social Security Number of the Plan Participant is as follows:
4. Alternate Payee's Name and Mailing Address: The name, last known mailing addressSocial Security Number __________________
and Social Security Number of the Alternate Payee is as follows:
5. Obligation of the Parties. It is the obligation of the parties to keep the Plan apprised ofSocial 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.
6. Order. On the next benefit payment date after receipt of this order (unless received too
late in the month, in which case on the next benefit payment date possible), the Plan shall set
aside and pay to the Alternate Payee the percentage, set forth in paragraph 2 above, of the Plan
Participant's monthly benefits, and shall continue said monthly payment to the Alternate Payee
until the earlier of the death of the Alternate Payee or the death of the Plan Participant.
7. 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); or (c) the payment of 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.
8. 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 and to issue further
orders as needed to enforce this order.
Judge of the District Court
(Must be certified by clerk of court.)
|Prepared by:||Approved by:|
|(Name, address and phone)||(Name, address and phone)|
Attorneys for Alternate Payee
Attorneys for Plan Participant
Information Prepared By: KPERS General Counsel