ERISA DEFINED CONTRIBUTION PLANS DIRECTIONS FOR COMPLETING THE FORM Section 1 and Section 2 This information can be found in the caption (top part of the first page) of the Property Settlement Agreement or Divorce Decree. Section 3 and Section 4 Participant (Employee Spouse) This is the individual who owns the Plan to be divided. Alternate Payee (Spouse or Former Spouse) This is the individual who is being awarded a portion of the Plan. Section 5 Date of Marriage Section 6 Divorce Date - This is the date the divorce was effective. If the divorce has not been finalized, leave this section blank. Section 7 Date Marriage Ended - This is the cut-off date for marital property rights relative to the pension. It is usually dictated by case law. This information may be found in the Property (Marital) Settlement Agreement or Divorce Decree. Section 8 Plan Name - It is necessary to have the exact legal name of the plan. This information can usually be found on a benefit statement or in a benefits handbook. Section 9 Date Participant Joined the Plan This is the actual date that the participant joined the plan. This date may not be the same day that the individual began employment. Section 10 Percent or Dollar Amount of Participant's benefits to be paid by the Plan to the Alternate Payee? Fill in a percent or dollar amount. This information can be found in the Property (Marital) Settlement Agreement or Divorce Decree (i.e. 50% or $10,000.00). If a percent is chosen, it shall be applied to Option #1 - The Participant's total account balance that has accumulated under the Plan as of the Date Marriage Ended. The Percent that the Alternate Payee is to receive would be applied to the balance in the account as of the Date Marriage Ended. The Date Marriage Ended is the date provided in (#5). Option #2 - The Participant's total account balance that has accumulated under the Plan as of a Specific Date. The Percent that the Alternate Payee is to receive would be applied to the balance in the account as of the Specific Date. Option #3 - The Participant's total account balance that has accumulated under the Plan as of a Specific Date less a Dollar Amount . The Percent that the Alternate Payee is to receive would be applied to the balance in the account as of the Specific Date and then a Dollar Amount would be deducted from the Alternate payee's portion. Option #4 - The Participant's total account balance that has accumulated under the Plan as of a Specific Date plus a Dollar Amount . The Percent that the Alternate Payee is to receive would be applied to the balance in the account as of the Specific Date and then a Dollar Amount would be added to the Alternate payee's portion. Option #5 - A Dollar Amount is deducted from the Participants total account balance as of a Specific Date and then the Percent is applied to the remaining balance. Option #6 - A Portion of the Participant's total account balance which was earned from the Date of Marriage to the Date Marriage Ended. The Plan will calculate and distribute a percent, as directed, from the balance of the account that was accumulated from the date of marriage (#3) to the Date Marriage Ended (#5). Section 11 Should the Alternate Payee receive gains/losses on his/her share of the benefits from the Date of Division (Cut-off-Date) to the Date of Segregation (Establishment of a separate account for Alternate Payee)? Option #1 - Yes The Alternate Payee would receive the proportionate share of any gains or losses which have occurred in the account from the agreed upon date of division (Date Marriage Ended) until the actual date that the money gets distributed to the Alternate Payee. Option #2 - No The Alternate Payee would not receive the proportionate share of any gains or losses which have occurred in the account from the agreed upon date of division (Date Marriage Ended) until the actual date that the money gets distributed to the Alternate Payee. Section 12 Distribution of Funds The Plan will distribute the funds as directed and set the Alternate Payee up as a separate participant in the Plan. The Alternate Payee will then be contacted by the Plan and provided with information concerning the rules and guidelines for being a participant in the plan. At that time the Alternate Payee will be provided the options available to roll money out of the account, withdraw money from the account, designate a beneficiary, etc.

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