When you complete the necessary forms, please send this information and payment to the following address:
|
|
- Logan Jordan
- 8 years ago
- Views:
Transcription
1 Dear Client, We would like to thank you for giving us the opportunity to assist you with the division of one of your most important assets and the preparation of the qualified domestic relations order(s) needed to complete this task. In order to begin, we will need you to complete the enclosed forms and return them to our office. We understand that this is typically a difficult time and we will do everything we can to facilitate this process in a timely and professional manner. We respectfully request that payment be made along with the submission of the enclosed forms. We will not begin work on your case until all necessary forms are received along with payment. Payment may be made by check or credit card (Visa, MasterCard, American Express and Discover). If you choose to make payment by check, please make check payable to QDRO Services, L.L.C. Credit card payments may be made by either completing the enclosed credit card form or by contacting our office directly. Enclosed you will find (5) forms: (i) QDRO Fee & Service Agreement, (ii) Attorney Information Sheet & Agreement, (iii) QDRO Checklist, (iv) Time Line and (v) Credit Card Form. (i). QDRO Fee & Service Agreement: This form simply states the terms and conditions under which we will provide our services. Please review and sign. (ii). Attorney Information Sheet & Agreement: Please provide the name of the attorney who currently represents you and then sign and date. If you did not have an attorney or currently do not retain counsel, please indicate this by checking the appropriate blank and then sign and date. (iii). QDRO Checklist: This Checklist is made up of (3) pages. The first page prompts you for the necessary information we will need to prepare the proposed QDRO/DRO. It is important that you complete this form to the best of your ability, as missing information could affect the quality of the document(s) and the efficiency in which we complete our service. The second page will inform you of the documents we need. The third page is a release authorization. In most cases, this document is not needed. However, if you would like to know the value of the account/accrued benefit or if you 1
2 think that there may be more to the story, we will need this document signed by the Participant/Employee and notarized. (iv). Time Line: This form needs no signatures and is your to keep. It simply provides you with a better idea of the time needed to complete our service. These times are not set in stone and are subject to change depending on the circumstances of your case. (v). Credit Card Form: This must be completed only if you wish to pay by credit card. When you complete the necessary forms, please send this information and payment to the following address: QDRO Services, L.L.C. P.O. Box 1569 Spring, Texas If you would prefer, you may fax the information to (281) or you may it to richardj@qdrosvc.com (please insert New Case, as the subject). If you have any questions regarding our services, or if we can be of any assistance, please feel free to contact us at (281) We welcome the opportunity to assist you with your QDRO needs. Thank you, Richard D. Johnston, Jr. QDRO Services, L.L.C. 2
3 QDRO FEE & SERVICE AGREEMENT This statement sets forth the terms of engagement offered to you by QDRO Services, L.L.C. Unless modified in writing by mutual agreement, these terms will control all services rendered by QDRO Services, L.L.C. until termination of this Fee & Services Agreement. Please retain a copy of this Fee & Services Agreement for your records. A. QDRO POLICIES: You have retained QDRO Services, L.L.C. to prepare a Qualified Domestic Relations Order ( QDRO ) or similar Order. In order to prepare the proposed QDRO, we require a copy of the following items before we begin work: A copy of the Final Decree of Divorce or Property Settlement Agreement A copy of the statement(s) for each retirement plan being divided A copy of the summary plan description for each plan (if possible) A completed copy of our QDRO Checklist A signed QDRO Fee & Services Agreement A Release Authorization signed by the employee (if possible) Base Payment Note: Failure to provide the information requested above may result in delays and in some cases could prevent a QDRO from being prepared. B. FEES: Our rates are outlined in more detail in our Fee Schedule, which are subject to revision from time to time. Any services requested by you in addition to the QDRO(s) will be paid by you at the rate of $250/hr. (i.e. tracing of a defined contribution plan, present value calculation of a defined benefit plan, discovery, etc.). Any additional charges will be discussed with the client/attorney prior to commencement of service. You agree that if you request hourly rate services, we have no obligation to render such services before payment of the hourly rate in advance, based upon a good faith time estimate, if we request such payment. C. PAYMENT OF FEES: You agree to pay the applicable Fee(s) in advance. You agree that the Fee(s) is/are nonrefundable. You agree that our obligation to render the services do not begin until we receive the Fee(s) and approval of the terms of the QDRO Fee and Service Agreement from you. You agree that we have no obligation to render the services until we receive all necessary information requested by us. D. TERMINATION: QDRO Services, L.L.C. reserves the right to decline or discontinue the services for such things as non-payment of fees or costs, conduct which renders it unreasonably difficult to carry out the engagement effectively, failure to provide information within a reasonable time or conflict of interest. QDRO Services, L.L.C. will immediately provide you with written notice that we have discontinued the services. 3
4 E. GENERAL: In some cases, depending on the jurisdiction and circumstances, an attorney s services may be required to complete this process. (For example, if the QDRO involves a contested issue or if one of the parties fails to sign the QDRO; the issue may require resolution by a Judge. If this is the case, you will need to retain an attorney to represent you in a legal capacity. QDRO Services, L.L.C. can be available for expert testimony in these cases. If QDRO Services, L.L.C. is requested to testify or assist in such cases, our hourly rate will apply. QDRO Services, L.L.C. is not a financial institution, bank, custodian or recordkeeper. QDRO Services, L.L.C. does not buy and/or sell financial securities, nor do we provide financial advice (i.e. estate planning or financial services). QDRO Services L.L.C. encourages you to seek competent advice from a financial expert for issues relating to distributions or estate planning. We are not attorneys and do not provided legal advice and/or interpret the intentions of the parties as it relates to the spirit of the agreement. The proposed QDRO will be prepared in accordance with the terms of the Final Decree of Divorce, Property Settlement Agreement or other governing Court Order. If the Court Order is not clear and/or silent on an issue, a letter will be sent out to you (or your designated representative) to clarify the issue(s) and a written response will be required. Any expressions on our part concerning the outcome of any legal matter or Judgment are not guaranteed. We strongly urge you to have a qualified attorney review the proposed QDRO on your behalf prior to signing and filing with Court. F. BASIC DRAFTING SERVICES: Our basic drafting service includes reviewing the documents provided, preparing the initial draft Order, submitting initial draft Order to the plan administrator for review prior to filing with the Court (when available), revising the initial draft at the request of the plan administrator, sending the proposed QDRO to you (or your designated representative) for your signature. You will be responsible for presenting the final document to all parties and their attorneys for signatures. You will be responsible for submitting the Order to the appropriate court for entry (unless previously agreed). It is your duty to either notify our office in writing if you would like for QDRO Services, L.L.C. to retrieve the certified copy from the court or to provide a court certified copy (with a raised seal and/or colored ink, photo copies and scanned copies are not acceptable) to our office for submission to the administrator for final acceptance. Any additional services will be billed at an additional rate. Divorce Decree: Some administrators require a certified copy of the Divorce Decree along with the proposed QDRO (i.e. military and some state agencies). If this is the case, the cost of the certified copy of the Divorce Decree is not included in our fee. Therefore, you may either provide this to our office or we can request a copy from the court for an additional fee. Filing with Court: Unless previously agreed, QDRO Services, L.L.C. will not be responsible for filing the QDRO with the appropriate court. If our office is asked to file the QDRO(s) with the court, an additional fee of $50 per Order will be assessed and this fee will be due before filing services are rendered. Please note, QDRO Services, L.L.C. does not file documents in all counties; therefore this service is not available in all areas. In some cases, additional actions may be required to file the QDRO with the court which may prohibit us from accomplishing this step, in which case, you may need to acquire the services of any attorney. 4
5 G. EXECUTION OF AGREEMENT: By signing this Fee & Services Agreement, you understand that you have entered into an enforceable contract and accept the terms, conditions and obligations of this Fee & Service Agreement. You agree that you have freely and voluntarily entered into this Fee & Service Agreement with full understanding of the legal ramifications contained in this Agreement. Date: Signature of Attorney / Client: Print Name: Participant Last Name: 5
6 Dear Prospective Client: ATTORNEY INFORMATION SHEET & AGREEMENT In an effort to provide full disclosure, QDRO Services, L.L.C. wants to clearly state that we are not attorneys and we do not provide legal advice and/or interpret the intentions of the parties as it relates to the spirit of the agreement. Any expressions on our part concerning the outcome of any legal matter or Judgment are not guaranteed. We strongly urge you to have a qualified legal attorney review the proposed QDRO on your behalf prior to signing and filing with the Court. In addition, it is your responsibility to thoroughly read and understand the effects and consequences of the proposed QDRO. You agree that QDRO Services, L.L.C. can not and will not be held responsible for any misinterpretation of the intent of the parties or of the agreement of the parties. Please check one of the following: You are currently represented by a qualified legal attorney and his/her information is as follows: Attorney Name (Firm Name, if applicable): Attorney Phone No: Attorney Address: You are not currently represented by a qualified legal attorney. By signing below, you agree to accept the terms of this agreement. Client s Name Date Client s Signature 6
7 QDRO CHECKLIST (ERISA and Non-Qualified Plans) Participant/Employee Information: 1. Name: Phone: 2. Address: City: State: Zip: 3. Social Security Number: 4. Date of birth: 5. Date of Employment: 6. Retired (Yes/No): 7. Have Benefit Payments Commenced (Yes/No): Alternate Payee/Non-Employee Information: 1. Name: Phone: 2. Address: City: State: Zip: 3. Social Security Number: 4. Date of birth: 5. Date of marriage: 6. Date of divorce: 7. Date of division (if different from date of divorce): Plan information: Name: 1. Company/Sponsor: Phone: FAX: 2. Plan Names: a. b. 7
8 Please provide the indicated exhibits: QDRO CHECKLIST (Page 2) 1. Copies of latest plan statements. Very Important. 2. Copy of any pleading with style of case, case number, attorneys names, addresses, phone, fax and State Bar numbers. 3. Copy of decree, judgment, agreement, Rule 11, etc. 4. Copy of latest retirement check information (if retired). 5. Please draft QDRO. Fee $ (Call or visit our website at for a fee schedule). Please provide the following: 1. Copies of latest plan statement (for each plan to be divided). Very Important. 2. Copy of decree, judgment, agreement, Rule 11, etc.; attorneys names, addresses, phone, fax and State Bar numbers. 3. Copy of latest retirement check information (if retired). 4. (Check one) QDRO Services, L.L.C. will or will not file the QDRO(s) with the court. Note QDRO Services does not file in all counties. Be sure to confirm whether this service is available in the appropriate county. The fee for filing the QDRO with the court is $50 per Order. 8
9 SPECIAL INSTRUCTIONS OR REQUESTS: Attorney / Client s signature: Attorney / Client to be invoiced: Address to be invoiced: Transmit correspondence by to the following mailbox: NOTE: Fees are payable in advance prior to commencement of work 9
10 Employee Name: RETIREMENT INFORMATION RELEASE AUTHORIZATION Date of Birth: S.S.N.: Street: City: State: Zip: Employer: Date of Marriage: Date of Divorce / Separation: The above named Participant hereby gives consent for the Plan Administrator (or agents) to provide any and all information concerning any qualified or non-qualified plan benefits to necessary parties named below for the sole purpose of preparing a Qualified Domestic Relations Order or similar Order. Information shall include providing the following: Copies of Summary Plan Descriptions Copies of sample QDRO/DRO Copies of current plan benefit statement(s) and procedures for processing Contact name, phone & fax number, and address of the Plan Administrator. Account Balances and/or Accrued Benefits as of the date of marriage and the date of divorce. Necessary Parties: 1. QDRO Services, L.L.C.: Richard D. Johnston Tel: Mailing Address: P.O. Box 1569, Spring, Texas Overnight Address: 3 Grogan s Park Drive, Ste. 212, The Woodlands, Texas Attorney for Alternate Payee: 3. Attorney for Participant: Participant s / Employee s Signature Date Notary Public Date A photo or facsimile of this statement shall be valid as an original. 10
11 TIME LINE Dear Client: In an effort to better serve you, below are the key steps involved in the preparation and completion of your domestic relations order. The times provided are averages and may vary based on the employer and terms of your case. While most preparation times will fall within this time period, some may take longer due to unforeseen reasons; such as lack of accurate information, changing the deal, etc. I can assure you that our staff is committed to completing this task as quickly as possible, but not at the risk of quality. In some cases, some of these steps can be eliminated; however, by doing so, the process may be extended due to necessary corrections that may be required down the road. If you are interest in shortening the preparation time due to your circumstances, please inform one of our QDRO experts to discuss the possible effect. 1. Initial Request and Preparation of QDRO (or similar order): (7-10 Bus. Days) This is a very important step. In order to accurately prepare your proposed QDRO, we must have the necessary information to complete the initial draft. This information includes a copy of the Divorce Decree (or Mediated Settlement Agreement, Rule 11, etc.), a copy of a recent plan statement regarding whatever plan is to be divided, the parties names, mailing addresses, dates of birth, Social Security Numbers, the date of marriage, the date of divorce (if it is finalized) and the date the plan is to be divided (if it is different from the date of divorce). If any of this requested information is not provided, it could cause the processing time to be extended until such information is provided. 11
12 2. Submission of the Draft QDRO to the Plan for Review: (2-30 Bus. Days) This time is determined by each Plan and is subject to fluctuation based on the procedures of the Plan. This step is not required; however, it is very important in most cases. This is where the proposed QDRO is submitted to the Plan for review to determine whether the proposed QDRO would be acceptable to the Plan in its current format once it has been filed with the Court. In many cases, revisions may need to be made at the request of the Plan. It is much easier to make the changes now, than to wait until after the proposed QDRO has been signed by the parties, filed with the court and submitted to the Plan for acceptance. In some case, the Plan will not review draft Orders prior to being filed with the Court (and they are not required to do so). If this is the case, the draft will be forwarded to the attorney(s) for review and signatures. (Please note that there is no time limit for a Plan to review a draft order.) 3. Revise & Forward the Proposed QDRO to the Client for Signatures: (Subject to Parties) Once we receive a response from the Plan regarding the draft QDRO, we will make the necessary changes to the proposed QDRO, if any. If the requested changes may affect the intent or the substance of the QDRO, we will contact the attorney(s) to discuss. Generally, most changes can be made within 3-5 business days. It may be longer if we need to discuss the changes with the Plan or attorney due to clarity or intent. Once the proposed QDRO is ready to be signed by the parties, the proposed QDRO will be sent to the attorney / client for signatures. At this point, the time line is subject to the length of time it takes for the parties to review and sign the proposed QDRO. 4. File the Proposed QDRO with the Appropriate Court: (4-6 weeks) Once the proposed QDRO has been signed by all the necessary parties and the signed Order has been sent back to our office, the proposed QDRO will be filed with the appropriate court within (3-5 business days). Once the Order has been filed with the Court and signed by a Judge, we will retrieve a Court Certified Copy of the proposed QDRO. Depending on the Court, the time it takes for the Judge to sign the proposed QDRO and make it available for pick-up may vary. 5. Submit the Proposed QDRO to the Plan for Final Acceptance: (2-6 weeks) Once we retrieve a Certified Copy of the proposed QDRO from the Court, the Certified Copy will be sent via Certified Mail (with a return receipt request) to the Plan for acceptance as a QDRO. At this point, the proposed QDRO is out of our hands and it is up to the Plan to complete the QDRO processing. Once the Plan has made a final determination, the Plan is required by law to contact the parties to inform them of the final results. At this point, the Plan will provide instructions regarding the form and timing of your benefit. 12
13 As you can see, this process is a lengthy one. Times vary based on the Plan and the circumstances of the case. While we welcome the opportunity to answer your questions, please understand that we are working with the Plan to secure your benefit in a timely manner without sacrificing quality. If you have any questions, please contact our office at (281) Thank you, QDRO Services, L.L.C. 13
14 Credit Card Authorization Form I hereby authorize QDRO Services, LLC to charge my credit card for $ _which is payment in full for the drafting (and administration) of the Qualified Domestic Relations Order(s) relating to my divorce case. Cause No.: ; In the Matter of the Marriage of: Credit Card Type: AMEX VISA MasterCard Discover Credit Card Number: Full name as it appears on card: Expiration date: Please enter BILLING ADDRESS for credit card: Date: Cardholder Signature Print Name Cardholder s Telephone: Attorney: Invoice No.: (To be completed by our office) 14
QDRO APPROVAL GUIDELINES AND PROCEDURES
QDRO APPROVAL GUIDELINES AND PROCEDURES Retirement Plan of Marathon Oil Company Effective date of this document: January 1, 2012 FOR ASSISTANCE CREATING A QDRO, GO TO: ****** QDRO.FIDELITY.COM *******
More informationSELECT SERVICES FLAT FEE REPRESENTATION AGREEMENT page 1 of 8
Utah Family Law, LC Tel. No. 801-466-9277 E-mail: eric@divorceutah.com Attorney Eric K. Johnson - Attorney Russell W. Hartvigsen Mail: 2666 South 2000 East, Suite 101 Salt Lake City Utah 84109 REMEMBER:
More informationCITY OF SAN JOSE DEFERRED COMPENSATION PLAN
CITY OF SAN JOSE DEFERRED COMPENSATION PLAN Joinder of the Plan in Marital Dissolution Matters and Requirements for Conforming Domestic Relations Orders This document provides information about the Deferred
More informationLaborers Annuity Plan for Northern California 220 Campus Lane, Fairfield, CA 94534-1498 Telephone: (707) 864-2800 Toll Free: 1-(800) 244-4530
Laborers Annuity Plan for Northern California 0 Campus Lane, Fairfield, CA - Telephone: (0) -00 Toll Free: 1-(00) -0 INFORMATION FOR DRAFTING A QDRO DIVIDING COMMUNITY PROPERTY INTERESTS IN THE LABORERS
More informationLUMP SUM BENEFIT APPLICATION
NATIONAL ELECTRICAL ANNUITY PLAN NEAP LUMP SUM BENEFIT APPLICATION 2400 Research Boulevard, Suite 500, Rockville, MD 20850-3266 Telephone (301) 556-4300 Rev 01/12 National Electrical Annuity Plan Lump
More informationBETH G. REINEKE, ESQUIRE 1003 W. CLEVELAND STREET TAMPA, FL 33606
BETH G. REINEKE, ESQUIRE 1003 W. CLEVELAND STREET TAMPA, FL 33606 BOARD CERTIFIED EMERITUS FAMILY ATTORNEY CERTIFIED FAMILY LAW MEDIATOR September 18, 2014 TELEPHONE: (813) 205-6675 EMAIL: BETH@BETHREINEKE.COM
More informationLicense Application for a Life Settlement Provider or Broker
License Application for a Life Settlement Provider or Broker The Life Settlement Provider s and Broker s application requires four (4) categories of information: Section I Application Form and Fee Section
More informationNational Electrical Annuity Plan Lump Sum Benefit Application
National Electrical Annuity Plan Lump Sum Benefit Application To avoid delays in the processing and payment of your benefit, please follow these instructions carefully and completely. 1. Print all information
More informationWE MAY NOT BE ABLE TO TIMELY COMPLETE THIS PROCESS IF WE DO NOT RECEIVE THIS INFORMATON AT LEAST TWO (2) DAYS BEFORE YOUR SCHEDULED COURT APPEARANCE.
We look forward to favorably resolving your traffic ticket/criminal law matter. Simply print this form and fill in the blanks. If this involves a traffic ticket, we understand that you want three things
More informationThe Payment Authorization Letter is needed to transact an earnest money deposit
REAL ESTATE PURCHASE PROCESS Having established your Vantage Self-Directed IRA and funded your account, below is a high level flowchart to assist you in the transaction process of investing in Real Estate.
More informationAfter reviewing this publication, if you have questions or concerns, contact the TMRS Support Services Department:
Divorce & Retirement Purpose of this Publication For most members of the Texas Municipal Retirement System (TMRS ), their accumulated benefit is one of the most valuable assets that they own. It is very
More informationDissolution of Marriage Overview and Frequently Asked Questions for the County of Los Angeles Defined Contribution Plans
Dissolution of Marriage Overview and Frequently Asked Questions for the Defined Contribution Plans This document is intended for general information use only for the Defined Contribution Plans. Nothing
More informationHealth Savings Account Packet
Health Savings Account Packet Please mail completed forms to: Jones National Bank & Trust Co. Attn: HSA Department PO Box 469 Seward NE 68434-0469 Questions, please call 402-643-3602 or 888-562-3602 Fax
More informationPIERCE COUNTY DISTRICT COURT 930 TACOMA AVE S, Room 239, TACOMA, 98402. Small Claims Information
930 TACOMA AVE S, Room 239, TACOMA, 98402 Small Claims Information A Small Claims case can be filed for the recovery of money only. This amount cannot exceed $5,000. LEGAL ADVICE The clerk will assist
More informationINSTRUCTIONS TO EMPLOYER. What to do when a participant terminates employment
INSTRUCTIONS TO EMPLOYER What to do when a participant terminates employment 1. Print the following distribution forms and give them to the terminated participant. The required forms include: a. Instructions
More informationForm 503 General Information (Assumed Name Certificate) Commentary
Form 503 General Information (Assumed Name Certificate) The attached form is drafted to meet minimal statutory filing requirements pursuant to the relevant code provisions. This form and the information
More informationATTORNEY-CLIENT CONTRACT. The Firm has agreed to represent you in a case involving.
ATTORNEY-CLIENT CONTRACT The Undersigned, sometimes referred to as Client and Peterson Law Group, sometimes hereinafter referred to as Firm hereby enter into the following contract and agreement regarding
More informationQualified Domestic Relations Order
The FRS Investment Plan Qualified Domestic Relations Order Procedures Index I. Qualified Domestic Relations Order (QDRO) Overview 1 What s a Domestic Relations Order? 1 What s a Qualified Domestic Relations
More informationPROOF OF CLAIM AND RELEASE
Deadline for Submission: April 22, 2015 Uni Pixel, Inc. Litigation c/o Strategic Claims Services P.O. Box 230 600 N. Jackson St., Ste. 3 Media, PA 19063 Tel.: 866 274 4004 Fax: 610 565 7985 info@strategicclaims.net
More informationNEW YORK CITY DEFERRED COMPENSATION PLAN (NYCDCP) DOMESTIC RELATIONS ORDER PROCEDURES
NEW YK CITY DEFERRED COMPENSATION PLAN (NYCDCP) DOMESTIC RELATIONS DER PROCEDURES Effective December 8, 2015 This booklet is designed to assist the parties involved in a divorce, separation or dissolution
More informationForm 312 General Information (Application for Registration of a Foreign Business Trust, Real Estate Investment Trust or Other Foreign Filing Entity)
Form 312 General Information (Application for Registration of a Foreign Business Trust, Real Estate Investment Trust or Other Foreign Filing Entity) The attached form is drafted to meet minimal statutory
More informationAFFORDABLE DIVORCE & FAMILY LAW
GARY A. HINCHMAN ATTORNEY AT LAW 11811 North Freeway SUITE #517 HOUSTON, TEXAS 77060 (281) DIVORCE OR 1-800-DIVORCE FAX: 281-436-7283 E-Mail: affordable_divorce@yahoo.com www.divorceattorneyhouston.com
More informationCONSENT OF BOARD OF MANAGERS RETIREMENT PLAN OF NORFOLK SOUTHERN CORPORATION AND PARTICIPATING SUBSIDIARY COMPANIES
CONSENT OF BOARD OF MANAGERS RETIREMENT PLAN OF NORFOLK SOUTHERN CORPORATION AND PARTICIPATING SUBSIDIARY COMPANIES PROCEDURES GOVERNING QUALIFIED DOMESTIC RELATIONS ORDERS As Amended Effective June 16,
More informationCITY OF LOS ANGELES CALIFORNIA
BOARD OF DEFERRED COMPENSATION ADMINISTRATION EUGENE K. CANZANO CHAIRPERSON RICHARD KRAUS VICE-CHAIRPERSON -- SANGEETA BHATIA CLIFF CANNON TOM MOUTES JOHN R. MUMMA MICHAEL A. PEREZ ROBERT SCHOONOVER MARGARET
More informationForm 304 General Information (Application for Registration of a Foreign Limited Liability Company) Commentary
Form 304 General Information (Application for Registration of a Foreign Limited Liability Company) The attached form is drafted to meet minimal statutory filing requirements pursuant to the relevant code
More informationWhen should these forms be used?
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORMS 12.920(a) MOTION FOR REFERRAL TO GENERAL MAGISTRATE 12.920(b) ORDER OF REFERRAL TO GENERAL MAGISTRATE and 12.920(c) NOTICE OF HEARING BEFORE
More informationCity of Kennedale c/o Art in the Park 405 Municipal Drive Kennedale, TX 76060
Dear Art Festival Applicant: The Art in the Park Committee and the City of Kennedale invite you to apply to participate in the Fifth Annual Art in the Park Arts Festival to be held April 4 6, 2014. Please
More informationAccounts Payable Contact Information. AP Contact Person: Email: Bill to Information. Bill to Company Name: Bill to Street Address: City: State: Zip:
Customer Packet Welcome to SICO America Inc. We are setting your company up in our system as a new SICO America Inc. customer. Please see the attached new customer packet. This packet includes our Credit
More informationDomestic Relations Orders (DRO) Questions Answers
FPPA Domestic Relations Orders (DRO) Questions Answers for FPPA & Administered Pension Plans For your convenience, FPPA has compiled a listing of the most frequently requested information. We hope this
More informationResidential Builders New Application
State of Arkansas CONTRACTORS LICENSING BOARD Residential Builders New Application $100.00 Filing Fee - NON-REFUNDABLE MAIL TO: CONTRACTORS LICENSING BOARD 4100 RICHARDS ROAD NORTH LITTLE ROCK, ARKANSAS
More informationAuction Entry Package for CCA's 1 st Annual Cave Creek Motorcycle Auction Event scheduled for March of 2012 at Harold's Corral Bar & Grill
Auction Entry Package for CCA's 1 st Annual Cave Creek Motorcycle Auction Event scheduled for March of 2012 at Harold's Corral Bar & Grill Thank You for Choosing Cave Creek Auctions & Events to assist
More informationOPERATING ENGINEERS TRUST FUNDS
OPERATING ENGINEERS TRUST FUNDS 1640 South Loop Road Alameda, CA 94502 P.O. Box 23190 Oakland, CA 94623-0190 Telephone (510) 433-4422 or (510) 271-0222 or Claims Department (800) 251-5013 Pension Department
More informationSpecial Power of Attorney
Special Power of Attorney 888 CalPERS (or 888-225-7377) TTY: (877) 249-7442 Section 1 When completing this form, please be sure to print the requested information. For the purpose of this form, a principal
More informationHuron County Juvenile Court
Huron County Juvenile Court Instructions for: CHILD CARE POWER OF ATTORNEY AND CARETAKER AUTHORIZATION AFFIDAVIT This packet was prepared for your convenience and ease in filing a child care power of attorney
More informationDECREE OF LEGAL SEPARATION WITHOUT CHILDREN
Revised 12.19.12 DECREE OF LEGAL SEPARATION WITHOUT CHILDREN I N A N D F O R T H E C O U N T Y O F P I N A L PINAL COUNTY FORMS Provided as a Public Service by AMANDA STANFORD Clerk of the Superior Court
More informationHealth Savings Account Packet
Health Savings Account Packet Please mail completed forms to: Jones National Bank & Trust Co. Attn: HSA Department PO Box 469 Seward NE 68434-0469 Questions, please call 402-643-3602 or 888-562-3602 Fax
More informationLAWYERS FUND FOR CLIENT PROTECTION Established by the Maine Supreme Judicial Court P O Box 5084 Augusta, ME 04332-5084
LAWYERS FUND FOR CLIENT PROTECTION Established by the Maine Supreme Judicial Court P O Box 5084 Augusta, ME 04332-5084 Phone 207-623-7801 Fax 207-623-4175 CLAIM FORM FOR REIMBURSEMENT Information and Instructions
More informationSTATE EMPLOYEES RETIREMENT SYSTEM - DEFINED BENEFIT PLANS -
STATE EMPLOYEES RETIREMENT SYSTEM - DEFINED BENEFIT PLANS - PROCEDURES AND GUIDELINES FOR DETERMINING QUALIFIED STATUS OF A DOMESTIC RELATIONS ORDER I. INTRODUCTION The State Employees Retirement System
More informationDISCRETIONARY INVESTMENT ADVISORY AGREEMENT
DISCRETIONARY INVESTMENT ADVISORY AGREEMENT This Discretionary Investment Advisory Agreement (this Agreement ) is between (the "Client") and LEONARD L. GOLDBERG d/b/a GOLDBERG CAPITAL MANAGEMENT, a sole
More informationAPPLICATION FOR REGISTRATION:
APPLICATION FOR REGISTRATION: POSTGRADUATE EDUCATION - 2015 CANADIAN MEDICAL SCHOOL GRADUATES MATCHED TO AN ONTARIO RESIDENCY PROGRAM Dear Applicant: The College is pleased to provide this application
More informationL.A. Tax Service, LLP 8350 MELROSE AVE. 2 ND Fl. #202 LOS ANGELES, CA 90069 TEL: (323) 658-5271 FAX: (323) 658-1114. Client Name: Dear Client,
L.A. Tax Service, LLP 8350 MELROSE AVE. 2 ND Fl. #202 LOS ANGELES, CA 90069 TEL: (323) 658-5271 FAX: (323) 658-1114 L. A. TAX SERVICE, LLP L. A. TAX SERVICE, LLP L. A. TAX SERVICE, LLP Client Name: Dear
More informationFORM 628-15 APPLICATION TO BECOME A CERTIFIED INVESTMENT ADVISER INSTRUCTIONS FOR FORM 628-15
FORM 628-15 APPLICATION TO BECOME A CERTIFIED INVESTMENT ADVISER INSTRUCTIONS FOR FORM 628-15 1. Authority This form must be completed by any investment adviser who wishes to become a certified investment
More informationFLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS
FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS Attached are the form and instructions to dissolve a Florida Limited Liability Company. A limited liability company can voluntarily dissolve by filing
More informationCourt-Ordered Benefits for Former Spouses
Court-Ordered Benefits for Former Spouses Civil Service Retirement System Federal Employees Retirement System Federal Employees Group Life Insurance Federal Employees Health Benefits RI 84-1 Revised July
More informationPROFESSIONAL COUNSELSM
PROFESSIONAL COUNSELSM ADVICE AND INSIGHT INTO THE PRACTICE OF LAW Lawyers Toolkit 3.0: A Guide to Managing the Attorney-Client Relationship A CNA PROFESSIONAL COUNSEL GUIDE FOR LAWYERS AND LAW FIRMS The
More informationQUALIFIED ILLINOIS DOMESTIC RELATIONS ORDERS
QUALIFIED ILLINOIS DOMESTIC RELATIONS ORDERS QILDRO Information for Policemen's Annuity and Benefit Fund [PABF] Members in Divorce Proceedings TABLE OF CONTENTS Foreword...2 Disclaimer...2 Timeline of
More informationDOL Provides Guidance on Qualified Domestic Relations Orders
Important Information Plan Administration and Operation September 1997* DOL Provides Guidance on Qualified Domestic Relations Orders WHO'S AFFECTED Qualified Domestic Relations Order rules apply to all
More informationHOOVER FINANCIAL ADVISORS, PC FINANCIAL PLANNING AND CONSULTING AGREEMENT
FINANCIAL PLANNING AND CONSULTING AGREEMENT This financial planning and/or consulting agreement ( Agreement ) made as of the day of, 2016 between the undersigned party, ( Client ), the Investment Advisory
More informationThe Uncontested Divorce Process in Texas
The Uncontested Divorce Process in Texas This guide is intended to help you use the divorce forms provided by www.texaslawhelp.org for an uncontested divorce. Is your divorce contested? -Or- Is your divorce
More informationBUSINESS CREDIT CARD AGREEMENT
Thank you for your interest in CoVantage Credit Union s business credit card services. We offer two options for our business credit card users, although basic features of the card are available on either
More informationCincinnati Academy of Collaborative Professionals Collaborative Family Law Participation Agreement. The undersigned, and, (referred to individually
Cincinnati Academy of Collaborative Professionals Collaborative Family Law Participation Agreement 09.21.2011 The undersigned, and, (referred to individually as party, or collectively as the parties )
More informationINFORMATION AND DOCUMENTATION REQUIRED FOR PETITION FOR UNCLAIMED FUNDS
INFORMATION AND DOCUMENTATION REQUIRED FOR PETITION FOR UNCLAIMED FUNDS I. A request BY AN OWNER OF RECORD for payment of Unclaimed Funds must include the following documents Petition for Payment of Unclaimed
More informationAdoptLink will provide an unlimited number of profile booklets for presentation to mothers presented by AdoptLink.
AdoptLink Agreement This document will set forth our agreement with respect to fees and adoption facilitation services and other possible related direct costs, as well as mutual commitments to each other.
More informationForm 313 General Information (Application for Registration of a Foreign Series Limited Liability Company) Commentary
Form 313 General Information (Application for Registration of a Foreign Series Limited Liability Company) The attached form is drafted to meet minimal statutory filing requirements pursuant to the relevant
More informationPROOF OF CLAIM AND RELEASE
DYP Securities Litigation 600 N. Jackson St., Ste. 3 Tel.: 866-274-4004 Fax: 610-565-7985 info@strategicclaims.net PROOF OF CLAIM AND RELEASE Deadline for Submission: October 9, 2013 IF YOU PURCHASED OR
More informationGrandparent s Power of Attorney Information and Forms
NOTICE AND DISCLAIMER Grandparent s Power of Attorney Information and Forms The forms in this packet have been provided to you as a public service by the Butler County Juvenile Court. Although you may
More information6) Any other form acceptable to the appropriate GAIG company.
Member Companies: Great American Life Insurance Company Annuity Investors Life Insurance Company Manhattan National Life Insurance Company Administrator for: Loyal American Life Insurance Company United
More informationCALIFORNIA FALSE CLAIMS ACT GOVERNMENT CODE SECTION 12650-12656
CALIFORNIA FALSE CLAIMS ACT GOVERNMENT CODE SECTION 12650-12656 12650. (a) This article shall be known and may be cited as the False Claims Act. (b) For purposes of this article: (1) "Claim" includes any
More informationBMA ADVISORS, LLC Investment Advisory Agreement
BMA ADVISORS, LLC Investment Advisory Agreement 608 Silver Spur Road, Suite 100, Rolling Hills Estates, CA 90274 This agreement describes the relationship between BMA Advisors, LLC (hereinafter BMA ) and
More informationStorm Damage Arbitration Agreement ADR Systems File # xxxxxxxxx Insurance Claim # xxxxxxxxxx
Storm Damage Arbitration Agreement ADR Systems File # Insurance Claim # x I. Parties A. xxxxx B. xxxxx II., Time and Location of the Arbitration : Time: Location: III. Rules Governing the Arbitration Each
More informationInvestment Advisory Agreement
This Investment Advisory Agreement ( Agreement ) is entered into by and between ( Client ), SPC Financial (SPC) a U.S. Securities & Exchange Commission ( SEC ) Independent Registered Investment Adviser,
More informationNo-Fault Divorce Under 3301(c) of the Divorce Code Instructional Checklist MUTUAL CONSENT
No-Fault Divorce Under 3301(c) of the Divorce Code Instructional Checklist MUTUAL CONSENT This section explains the basic forms needed for a plaintiff to file a simple Mutual Consent No- Fault Divorce
More informationMerchant Application & Agreement Merchant Processing Terms & Conditions
Merchant Application & Agreement Merchant Processing Terms & Conditions MERCHANT # (ASSIGNED BY BANK) 100 Throckmorton Street, Suite 1800 Fort Worth, Texas 76102 MCC: MERCHANT APPLICATION & AGREEMENT ASSOCIATION
More informationCLS Investments, LLC Instructions for the Solicitor Application and Agreement
CLS Investments, LLC Instructions for the Solicitor Application and Agreement Please complete all fields on page 1 of the Solicitor Application and Agreement. Some general guidelines are set forth below.
More informationPACKET 9. Forms for a Petition for Temporary Custody When:
PACKET 9 Forms for a Petition for Temporary Custody When: 1. You are Extended Family or you reasonably believe that you are the father of the Minor Child(ren) 2. The child(ren) reside with you. EIGHTH
More informationIN THE COMMON PLEAS COURT, PREBLE COUNTY, OHIO
IN THE COMMON PLEAS COURT, PREBLE COUNTY, OHIO IN THE MATTER OF THE CIVIL AND CRIMINAL LOCAL RULES: ENTRY The following local rules are adopted to govern the practice and procedures of this Court, subject
More informationCHICAGO REGIONAL COUNCIL OF CARPENTERS WELFARE FUND QUALIFIED MEDICAL CHILD SUPPORT ORDER GUIDELINES AND PROCEDURES
CHICAGO REGIONAL COUNCIL OF CARPENTERS WELFARE FUND QUALIFIED MEDICAL CHILD SUPPORT ORDER GUIDELINES AND PROCEDURES Guidelines for Creating Qualified Medical Child Support Orders (including National Medical
More informationBefore You Begin. INSTRUCTIONS Trading Authority Form
INSTRUCTIONS Trading Authority Form Use this form to: grant trading authority to an authorized agent (someone who is not an account owner) remove or replace authorized agents update information on an authorized
More informationAGREEMENT BETWEEN THE UNIVERSITY OF TEXAS M. D. ANDERSON CANCER CENTER SERVICE PROVIDER for A PROJECT OF LIMITED SIZE OR SCOPE
AGREEMENT BETWEEN THE UNIVERSITY OF TEXAS M. D. ANDERSON CANCER CENTER SERVICE PROVIDER for A PROJECT OF LIMITED SIZE OR SCOPE This Agreement is made as of, 20 (the Effective Date ), by and between: The
More informationI/We enclose a fully executed copy of the Trustee Amendment for your records. I/We would also like to provide you with the information listed below.
Dear Fidelity Personal Trust Company, FSB: I/We enclose a fully executed copy of the Trustee Amendment for your records. I/We would also like to provide you with the information listed below. 1. Choose
More informationCounty of Santa Clara Office of the District Attorney
County of Santa Clara Office of the District Attorney TO: PROSPECTIVE NEW EMPLOYEES AND VOLUNTEERS OF THE OFFICE OF THE DISTRICT ATTORNEY SUBJECT: BACKGROUND AND RECORD CHECK Jeffrey F. Rosen District
More informationDistribution Request Form
Distribution Request Form READ THE ATTACHED IRS SPECIAL TAX NOTICE: IF YOUR PLAN ALLOWS FOR AN ANNUITY OPTION, READ THE WRITTEN EXPLANATION OF QUALIFIED JOINT AND 50% CONTINGENT SURVIVOR ANNUITY FORM OF
More informationFULL-TIME ESL AND TEST PREPARATION PROGRAMS NEW STUDENT APPLICATION
Continuing and Professional Studies One Bernard Baruch Way Box B1-116 New York, NY 10010-5585 Tel: 646-312- 5000 Fax: 646-312- 5101 CAPS@baruch.cuny.edu FULL-TIME ESL AND TEST PREPARATION PROGRAMS NEW
More informationDIVORCE PACKET YOUR LEGAL RIGHTS MAY BE BETTER PROTECTED WITH THE HELP OF AN ATTORNEY
DIVORCE PACKET YOUR LEGAL RIGHTS MAY BE BETTER PROTECTED WITH THE HELP OF AN ATTORNEY IF YOU AND YOUR SPOUSE HAVE A CHILD OR CHILDREN, OWN A HOME OR BUSINESS, OR IF EITHER SPOUSE HAS A PENSION OR RETIREMENT
More informationRAMOS LAW FIRM. This is the uncontested divorce contract for all parties with an agreed divorce. Unauthorized use of this contract is prohibited.
RAMOS LAW FIRM Texas Divorce - Uncontested Divorce Packet (Agreed) This is the uncontested divorce contract for all parties with an agreed divorce. Unauthorized use of this contract is prohibited. *Now
More informationThe Academy of Northern Kentucky Collaborative Professionals. Collaborative Participation Agreement
The Academy of Northern Kentucky Collaborative Professionals Collaborative Participation Agreement The undersigned, and, (referred to individually as party, or collectively as the parties ) hereby agree
More informationBCK Partners, Inc. COMPREHENSIVE FINANCIAL MANAGEMENT AGREEMENT
BCK Partners, Inc. COMPREHENSIVE FINANCIAL MANAGEMENT AGREEMENT AGREEMENT, made this day of 20, between the undersigned party (hereinafter referred to as the Client or You ) and BCK Partners, Inc., a Registered
More informationMiller Financial Services, LLC Advisory Services Agreement
Miller Financial Services, LLC Advisory Services Agreement This Agreement (the Agreement ) is made and entered into, by and between, Miller Financial Services, LLC (the Advisor ) and xx (the Client ),
More informationPERS Benefits and Qualified Domestic Relations Orders
PERS Benefits and Qualified Domestic Relations Orders www.nvpers.org This document has been prepared for members of the Public Employees Retirement System of Nevada to provide general information. It
More informationHOW TO OBTAIN A NEW CONTRACTOR LICENSE
HOW TO OBTAIN A NEW CONTRACTOR LICENSE These instructions apply to new licenses only. If you wish to add a classification or a qualifying party to an existing license, please see HOW TO ADD A CLASSIFICATION
More informationTHE JOHNS HOPKINS UNIVERSITY SUPPORT STAFF PENSION PLAN QUALIFIED PRE-RETIREMENT SURVIVOR ANNUITY NOTICE
THE JOHNS HOPKINS UNIVERSITY SUPPORT STAFF PENSION PLAN QUALIFIED PRE-RETIREMENT SURVIVOR ANNUITY NOTICE If you are married and die before you begin receiving retirement benefits under The Johns Hopkins
More informationSeneca Mortgage Servicing LLC Attn: Loss Draft Department P.O. Box 52009 Phoenix, AZ 85072. Re: Repair Process. Dear Borrower(s),
P.O. Box 52009 Phoenix, AZ 85072 Re: Repair Process Dear Borrower(s), Thank you for informing us of the damage to your property. We understand what a difficult time this is for you, and we would like to
More informationHCS RETIREMENT SERVICES
Distribution Form HCS RETIREMENT SERVICES 1095 South 800 East Orem, UT 84097 Phone 801-224-1900 Fax 801-224-1930 www.hcsretirement.com EMPLOYER: PERSONAL INFORMATION Last Name: S.S. #: First Name: Date
More informationPROOF OF CLAIM IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MINNESOTA
PROOF OF CLAIM IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MINNESOTA WILLIAM DEAN, individually, on behalf of himself and all others similarly situated, Plaintiff, Civ. No. 14-cv-00376 DFW/JSM
More informationHow To Make A Domestic Relations Order Valid
AMERICAN FEDERATION OF MUSICIANS AND EMPLOYERS PENSION FUND Procedures for Determining the Qualified Status of a State Domestic Relations Order Under current law, the American Federation of Musicians and
More informationORDER I. COURT ADMINISTRATION
IN THE CIRCUIT COURT FOR THE FIFTH JUDICIAL DISTRICT, BLOUNT COUNTY, TENNESSEE, DIVISIONS I AND II AND FOR THE CHANCERY COURT FOR BLOUNT COUNTY, TENNESSEE (BLOUNT COUNTY, CASES ONLY) ORDER PURSUANT TO
More informationSTATUTORY SHORT FORM POWER OF ATTORNEY FOR PROPERTY. Includes Amendments Required By Public Act 96-1195 Form Valid July 1, 2011
STATUTORY SHORT FORM POWER OF ATTORNEY FOR PROPERTY Includes Amendments Required By Public Act 96-1195 Form Valid July 1, 2011 NOTICE TO THE INDIVIDUAL SIGNING THE ILLINOIS STATUTORY SHORT FORM POWER OF
More informationDIVORCE WITHOUT MINOR CHILDREN For Respondent Only
Revised 1.1.15 DIVORCE WITHOUT MINOR CHILDREN For Respondent Only PINAL COUNTY NON-COVENANT MARRIAGE Response to Divorce Petition INSTRUCTIONAL FORMS Provided as a Public Service by Amanda Stanford Clerk
More informationThe Woodlands Divorce Guide. Answers to common questions about getting divorced in Montgomery County
The Woodlands Divorce Guide Answers to common questions about getting divorced in Montgomery County What is a Divorce? Divorce is a legal procedure to end a legal marriage relationship. It is available
More informationForm 309 General Information (Application for Registration of an Out-of-State Financial Institution) Commentary
Form 309 General Information (Application for Registration of an Out-of-State Financial Institution) The attached form is drafted to meet minimal statutory filing requirements pursuant to the relevant
More informationDEPENDENT ELIGIBILITY AND ENROLLMENT
Office of Employee Benefits Administrative Manual DEPENDENT ELIGIBILITY AND ENROLLMENT 230 INITIAL EFFECTIVE DATE: October 10, 2003 LATEST REVISION DATE: July 1, 2015 PURPOSE: To provide guidance in determining
More information2. Five years post-graduate degree experience with child custody issues that may include evaluations, therapy, and mediation.
I. Role of the Special Master The Special Master is a quasi-judicial role where an expert is given legal authority to make prompt recommendations in high conflict, crisis situations to the court and to
More informationPROFESSIONAL DESIGN FIRM REGISTRATION APPLICATION
PROFESSIONAL DESIGN FIRM REGISTRATION APPLICATION Additional application forms can be downloaded from the IDFPR Web site at www.idfpr.com. Types of Business Organizations - Corporation, Professional Service
More informationPLEASE PRINT CLEARLY IN BLUE/BLACK INK
PLEASE PRINT CLEARLY IN BLUE/BLACK INK PENSION OPTION AND BENEFICIARY FORM PENSION OPTION AND BENEFICIARY FORM FORMER 144 HOSPITAL DIVISION BASIC DEFERRED PENSION FORMER 144 HOSPITAL DIVISION BASIC DEFERRED
More information5c. Did the Wife have a Child with Another Man while Married to the Husband?
NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA. Cause Number: IN THE MATTER OF THE MARRIAGE OF Petitioner: Print first, middle and last name of the spouse filing for divorce. And Respondent: Print first,
More informationDistribution Form Subject to Joint & Survivor Annuity
Distribution Form Subject to Joint & Survivor Annuity Please refer to the Plan s Summary Plan Description (SPD) for reasons distributions that are allowed in your plan. You may review the SPD, your account
More informationDepending on your vested account balance, one of the following situations will apply:
To: Re: 401(k) Plan Participant Eligibility for 401(k) Plan Benefits This letter is to inform you that you currently have a balance in your former Employer s 401(k) Plan. As a former plan participant,
More informationFICA Alternative Plan Direct Rollover Request
www.bencorplans.com Instructions To request a direct rollover to an eligible retirement plan (including an IRA), complete all applicable sections of this form, obtain any required signatures, and return
More informationPSERS Divorce Guidelines
PSERS Divorce Guidelines Publication # 9681 09/2012 PSERS Divorce Guidelines Revised September 11, 2012 Public School Employees' Retirement System - Who are we?... 1 How is a PSERS retirement benefit affected
More informationHow To File A Family Law Case In California
DIVISION 7 FAMILY LAW Rule Effective 700. Subject Matter of the Family Law Court 07/01/2011 700.5 Attorneys and Self Represented Parties 07/01/2011 700.6 Family Law Filings 01/01/2012 701. Assignment of
More information