QDRO CHECKLIST (Military Plans)

 

Please fill out the checklist below and then submit for our review.

Alternatively, you can download the checklist here and corresponding release form here and then fax, email or mail, along with the applicable documents.

Fax: (281) 528-6113
Email: richardj@qdrosvc.com
Mail:
QDRO Services, L.L.C.
P.O. Box 1569
Spring, Texas 77383-1569

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Note: The use of the internet for communications with the firm will not establish an attorney-client relationship and messages containing confidential or time-sensitive information should not be sent.

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Instructions:
* (asterisk) indicates required fields.

Member Information:

Name: *

Email: *

Phone: *

Address: *

City: *

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip: *

Social Security Number:

Date of birth: mm/dd/yyyy

Former Spouse Information:

Name:

Phone

Address:

City:

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Social Security Number:

Date of birth: mm/dd/yyyy

Date of marriage: mm/dd/yyyy

Date of divorce: mm/dd/yyyy

Effective Date of Order
(if different from date of divorce): mm/dd/yyyy

Military Information:

Branch of Service:

a. U.S. Army. b. U.S. Air Force c. U.S. Navy d. U.S. Coast Guard e. U.S. Marines

Member’s Current Rank:

Date of entry in Service: mm/dd/yyyy

Monthly pension: $

Member’s Current
Pay: $

If retired, Date retired: mm/dd/yyyy

Survivor Benefit Plan:

Yes No

Please provide the indicated exhibits:*

1. Copy of any pleadings with style of case, case number, attorneys’ names, addresses, phone, fax and State Bar numbers. 2. Copy of decree, judgment, agreement, Rule 11, etc. as to all military benefits. 3. Copy of Form DD-214 (if retired). 4. Copy of latest Form DFAS-CL 7220/148 (if retired). 5. Please draft QDRO. Fee $
Payable with request.

SPECIAL INSTRUCTIONS OR REQUESTS:

Attorney / Mediator: *

Transmit correspondence by e-mail to the following mailbox: *

NOTE: Fees are payable in advance prior to commencement of work.