1 Any Attorney or Party

Any Street
2 Any Town, CA 55555

3 714-555-5555

4 Any Attorney or Party

8 Superior Court of the State of California

9 For the County of ___________________

10

11 In re the marriage of: ) Case No.

)
12 ) STIPULATED QUALIFIED DOMESTIC
) RELATIONS ORDER RE: DIVISION OF
13 Petitioner, ) ____________________ RETIREMENT
) BENEFITS
14 and )
)
15 Respondent. )
)
16 )
)
17

18
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25 Petitioner, __________, and Respondent, ______________________, and the

26 __________________________________ (Administrator) as administrator of the

27
(______ or Plan) hereby stipulate as follows:
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STIPULATED QUALIFIED DOMESTIC RELATIONS ORDER
 1 RECITALS
2 1. Petitioner and Respondent were married on DATE OF MARRIAGE and separated on
3
DATE OF SEPARATION, and this Court entered a judgment of dissolution of marriage on DATE
4
THAT JUDGMENT WAS ENTERED.
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2. This Court has personal jurisdiction over both Petitioner and Respondent and

7 jurisdiction over the subject matter of this Order and the dissolution of marriage action.

8 3. NAME OF PARTY JOINED AS A PARTY was properly joined as a party to the

9
Petitioner and Respondents dissolution of marriage action pursuant to sections 2060 through 2065
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of the California Family Code.
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STIPULATION
12

13 This Order is acceptable to the Administrator of the Plan. This Order creates and recognizes

14 the existence of the right of the Non-Member Spouse to receive a portion of the Member's benefits
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payable under an employer-sponsored pension plan that is qualified under Section 401 of the Internal
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Revenue Code (the "Code") and the Employee Retirement Income Security Act of 1974 ("ERISA").
17
It is intended to constitute a Qualified Domestic Relations Order ("QDRO") under Section 414 (p) of
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19 the Code, Section 206(d)(3) of ERISA and the Retirement Equity Act of 1984, P.L. 98-397.

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24 domestic-relations-order-for-california
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STIPULATED QUALIFIED DOMESTIC RELATIONS ORDER