[SAMPLE IRA ORDER]

DISCLAIMER: This model is for informational purposes only. It does not represent all of
the alternatives available in drafting a domestic relations order for assigning assets under
an IRA, nor does it cover all of the issues that arise in regard to domestic relations
matters. The parties to the order should consult with their attorneys to ensure that their
intentions are accurately reflected in the order submitted for review. The format of this
model Order may vary depending on the rules of the court in which the Order is obtained.

IN THE __________ COURT OF ________ COUNTY, _________ (STATE)

ACTION-LAW.

___________________
Plaintiff/Alternate Payee

No.___________________

vs.

___________________
Defendant/Participant COURT SEAL/STAMP HERE

DOMESTIC RELATIONS ORDER

This Order creates and recognizes the existence of Alternate Payee’s' right to

receive a portion of Participant's assets under one or more of the TIAA accounts

maintained under the Individual Retirement [Account][Annuity] (“IRA”) listed below.

AND NOW, THIS ___________ day of (__________), the Court finds as

follows:

1. a. The Participant is _________________, social security number ___-__-

____.

b. The Order applies to the IRA(s) identified in paragraph 5. below.

(Rev 11/2021)
 c. The Participant’s current and last known address

is_____________________________________________________________.

d. The Participant’s date of birth is ________________________.

2. a. The Alternate Payee is _______________ .

b. The Alternate Payee’s current and last known street address

is___________________________________________________________ .

c. The Alternate Payee’s mailing address is

Select One:

􀀀 same as the street address noted above.

􀀀 different, e.g. P.O. Box. The mailing address is:

______________________________________________________________.

d. The Alternate Payee’s Telephone Number is ____________.

e. The Alternate Payee’s Social Security Number is______________.

f. The Alternate Payee’s date of birth is __________________.

g. The Alternate Payee’s email address is ______________________.

h. The Alternate Payee is the

Select One:

􀀀 Spouse of the Participant.

􀀀 Former spouse of the Participant.

􀀀 Child or other dependent of the Participant.

(Rev 11/2021)
 3. The Court has jurisdiction of this domestic relations matter pursuant to (State)

law. This Order relates to the provision of

Select One or More, as applicable:

􀀀 marital property rights

􀀀 spousal support

􀀀 child support
to the Alternate Payee as a result of

Select One or More, as applicable:

􀀀 divorce or separate maintenance order

􀀀 spousal support order

􀀀 child support order

􀀀 other order requiring the division of IRA benefits,

dated [DATE], between the Alternate Payee and the Participant.

4. For purposes of calculating the Alternate Payee’s award, the Valuation Date

(i.e. the date the IRA is valued for purposes of calculating the Alternate

Payee’s award) is:

Date of Transfer (i.e. the date TIAA segregates the monies from the

Participant’s IRA(s) into the Alternate Payee’s IRA(s)).

(Rev 11/2021)
 5. This Order assigns to the Alternate Payee the following amounts from the

IRA(s) identified in this paragraph 5 (fill-in as applicable):

TIAA Contract No.: _____________ $_______ or _______%

CREF Contract No.: _____________ $_______ or _______%

Other Investments: _____________ $_______ or _______%

TIAA Contract No.: _____________ $_______ or _______%

CREF Contract No.: _____________ $_______ or _______%

Other Investments: _____________ $_______ or _______%

(Add additional tables as needed)

All amounts to be assigned are subject to the terms and conditions of the

contracts, including applicable liquidity restrictions.

6. Upon finalization of this Order, the current value of the amounts identified in

paragraph 5 shall be assigned to the Alternate Payee and shall become the

Alternate Payee’s sole and exclusive property.

7. The death of the Participant prior to the time an individual retirement account

is established for the benefit of the Alternate Payee pursuant to this Order

shall have no effect on the assignment to Alternate Payee.

8. The Participant’s beneficiary designations for each of the IRA(s) owned by

the Participant shall be determined in accordance with the terms of the

applicable IRA. All beneficiary designation changes must be properly

submitted by the Participant pursuant to the beneficiary designation

procedures under the IRA.

(Rev 11/2021)
 9. This Court reserves jurisdiction to issue further orders as needed to execute

this Order.

By the Court ______________________________ Date __________

Participant _______________________________ Date __________

Alternate Payee _____________________________ Date __________

COURT SEAL/STAMP HERE

(Rev 11/2021)