Pension Appraisers, Inc.: MILITARY CHECKLIST PRINT

Please print and complete this request form. After you have completed the request form you can fax it to: 610-770-9342 or mail it to: P.O. Box 4396, Allentown, PA 18105-4396. If you have any questions, please call 1-800-447-0084 to speak to one of our analysts.

MILITARY QUALIFYING COURT ORDER CHECKLIST MILITARY RETIREMENT SYSTEM (ARMY, AIR FORCE, NAVY, MARINES, COAST GUARD, ETC.)
REQUESTOR'S
Name:
Mailing Address:
City:	State: Zip Code:
Firm Name:
Telephone #:	Fax #:
Should the Requestor's name and/or Firm Name, address and Telephone number appear above the Legal Caption?
Option #1 - Yes Option #2 - No
Who do you Represent?
Plaintiff Petitioner
Defendant Respondent
In addition to the Judge's, what signature lines should come at the end of the Order?
None
Both Husband and Wife
Attorneys for Husband and Wife
Attorneys for Husband and Wife
Husband and Wife and Attorneys for Both
Opposing Atty. Name
1. Name of Plaintiff / Petitioner:
Name of Defendant / Respondent:
2. Name of Court:
State:	County:
Division:	Case/Docket Number:
3. PARTICIPANT: (Military Member)
Name of Participant: Date of Birth:
Last Known Mailing Address:
:Zip Code
Social Security Number:
4. ALTERNATE PAYEE: (Spouse or Former Spouse)
Name of Alternate Payee: Date of Birth:
Last Known Mailing Address:
:Zip Code
Social Security Number:
5. Marriage Date:
6. Divorce Date:
7. Date Marriage Ended: (Cut-off date used to determine marital coverture fraction i.e. separation date, complaint date, or divorce date.)
8. Exact Plan Name: Military Retirement System
Branch of Service:
Air Force Marine Corps
Air Force Reserve Marine Corps Reserve
Air National Guard Navy
Army Naval Reserve
Army Reserve Public Health Service
Army National Guard National Oceanic & Atmospheric Administration
Coast Guard Coast Guard Reserve
Date Participant Joined The Plan:
The Military Member:
is retired and receiving pension benefits.
The Date of Retirement was
is still active and participating in the Plan.
has terminated employment and is entitled to a pension, but has not reached retirement age. (Reserve or National Guard)
Were the Plaintiff and Defendant married for at least 10 years of the Participant's service in the Military? Yes No
If the answer is no, the Former Spouse cannot receive direct payment from the Military Retirement System as Marital Property. However, there is no length of marriage requirement for getting a share paid as support. If the parties were not married for 10 years should we structure the order to make direct payments for support? Yes No
9. Percent or Dollar Amount of Member's monthly retirement benefit to be paid by the Plan to the Former Spouse? No matter which option is chosen, the payment to the Former Spouse may not exceed exceed 50% of Member's Disposable Retired Pay.
Dollar Amount per Month: $ Percent: %
Option #1: Percent of Total as of the Date of Retirement: The Former Spouse will receive a percentage of the total accrued benefit as of the the Date of Retirement. (This option includes any pre-marital and post-marital credited service).
Option #2: Percent of the Marital Portion as of the Date of Retirement:
RESERVE PERSONNEL: The Marital Property Component shall be determined by a fraction, the numerator of which is the number of points accumulated by the Participant during the marriage and the denominator of which is the total number of points accumulated by the Participant at the time of Retirement (You must obtain information relative to the number of points accumulated)
FULL TIME PERSONNEL: The Marital Property Component shall be determined by a fraction, the numerator of which is the number of months of the Participant's participation in the Plan earned during the marriage and the denominator of which is the total number of months of the Participant's participation in the Plan through Retirement.
Option #3: Percent of the Marital Portion using "Frozen" Approach:
(ONLY APPLICABLE FOR FULL-TIME ACTIVE OR ACTIVE RESERVE PERSONNEL)
RESERVE PERSONNEL: The Martial Property Component shall be determined using a "frozen" approach. The Alternate Payee shall receive a % of the disposable military retired pay the Participant would have received had the Participant become eligible to receive military retired pay at age 60 at the rank of withpoints andyears of service for basic pay purposes (you must complete the blanks).
FULL TIME PERSONNEL: The Martial Property Component shall be determined using a "frozen" approach. The Alternate Payee shall receive a % of the disposable military retired pay the Participant would have received had the Member retired at the rank ofwithyears of creditable (you must complete the blanks).
10. Should the Former Spouse receive a pro-rata share of any Cost of Living Adjustments?
Option #1 - Yes (Only option if a Percentage is stated in Question #9)
Option #2 - No
11. When will Former Spouse's benefits start?
As soon as administratively feasible following the date the Order is found to be a Retired Pay Court Order or on the date the Military Member begins receiving Disposable Retired Pay, if later. (Only Option)
12. Length of time benefits will be paid by the Plan to the Alternate Payee.
Payments to the Alternate Payee stop when either the Participant or Alternate Payee dies, or at an earlier date if desired which is
13. Should the Former Spouse be entitled to a Survivor Benefit Plan (SBP) Annuity? (Means a recurring benefit that is payable, after the Military Member retires and dies, to a former spouse who has not remarried before becoming 55 years of age.)
Option #1 - No
Option #2 - Yes Maximum Possible Annuity (55% of Retired Pay before any reductions)
14. Payment can be made by check or credit card.
Credit Card: Mastercard American Express Visa Discover
Card Number:
	Expiration Date:
Name as it appears on the credit card:
Billing address of the credit card:
Signature:	Date: