Form Fl 460 – Fill Out and Use This PDF

Enter the name, state bar number, and address of the attorney or party without attorney or governmental agency, with the TELEPHONE NO. and FAX NO.

Check Modification if it applies, and check Child Support or Spousal or Family Support.

This order applies to the following named plan: enter the Name and Address of the Plan.

This order requires you to withhold a portion of the benefits payable under the Plan with respect to the Obligor/Participant: enter the full legal name and, if known, mailing address, date of birth, and employee identification number.

If Participant has commenced receiving benefits under the Plan in the form of monthly or other periodic payments or has applied to receive monthly or other periodic payments (if benefits are not in pay status and have not been applied for, see item 5; if benefits are payable in a lump sum, see item 3), withhold the following amounts from the monthly benefits otherwise payable to the Participant:

Enter $ per month for current child support, current spousal support and current family support, and for child support arrearages, spousal support arrearages and family support arrearages.

Enter the total monthly support obligation (sum of item 1a(1) through (6)).

If the total monthly support obligation exceeds 50 percent of Participant's periodic benefits, withhold the greater of 50 percent or the percentage, if any, set forth in item 12.

If Participant's benefits are payable on a periodic basis other than monthly (e.g., quarterly, semiannually, or annually), multiply each of the amounts in items 1a and 1b by the number of months included in the payment period, and withhold the adjusted amounts (subject to the limitations in item 1c, taking into account the adjustment of the amount in item 1b) from each benefit payment.

If the amount withheld is less than the total monthly support obligation, prorate the amount first to current child support, then to current family support, and then to current spousal support. Apply any remainder in the same order of priority to support arrearages.

For child support, spousal support and family support, enter the Amount $ and the As of (date) of the total arrearages for purposes of this order. Interest that has not been calculated or included is not waived.

Child Support: all amounts withheld or payable for child support under this order are for the benefit of the Alternate Payee: enter the name of each child and the date of birth of each child.

Amounts withheld for child support must be paid to an agent: enter the name, capacity, and mailing address of the agent to receive payments.

Spousal or Family Support: all amounts withheld or payable for spousal/family support under this order are for the benefit of the Spousal or Family Alternate Payee: enter the name, with date of birth, if available.

Name: DOB: Note: A separate Attachment to Qualified Domestic Relations Order for Support (form FL-461) that sets forth the social security number of any Spousal or Family Alternate Payee named in item 4c(1) must be completed and served on the Plan with a copy of this order.

(2) Amounts withheld for spousal or family support must be paid to (check one): the Spousal or Family Alternate Payee at the mailing address you enter, or the Spousal or Family Alternate Payee's Agent, with the name, mailing address, and capacity of the agent.

This order upon approval as a QDRO (check appropriate box, if either is applicable): amends/replaces any existing QDRO with respect to support for any Alternate Payee's named herein, or supplements but does not amend or replace any existing payment obligations under a previous QDRO issued with respect to any Alternate Payee named herein.

Maximum withholding percentage greater than 50%: if a maximum withholding percentage greater than 50% has been authorized by court order, check the box to the left and complete the following.

By order entered on (date), the court has determined that the maximum percentage of Participant's benefits under the Plan that are subject to withholding pursuant to item 1 of this order is (check one): 100%, or a percentage (if this box is checked, fill in the maximum percentage specified in the order).

14. OTHER PROVISIONS: the Plan must provide to the Alternate Payee, or to the Alternate Payee's agent, a copy of the Summary Plan Description; any subsequent summaries of material modifications with respect to the Plan; and the Plan's QDRO procedures, if any. Other (specify).

SIGN: the judicial officer signs and enters the Date.

Withhold from any lump sum distributions currently payable to Participant under the Plan as follows.

An amount equal to the total of the support arrearages, if any, set forth in item 2.

If the amounts withheld under item 3a are less than the total of the support arrearages, if any, set forth in item 2, prorate the amounts first to child support arrearages, then to family support arrearages, and then to spousal support arrearages.

The limitations on withholding set forth in items 1 and 12 do not apply to the withholding provisions of this item 3.

If benefits are not currently in pay status: If Participant applies for benefits (including a lump sum distribution) within 90 days after the Plan receives this order or while the temporary restraining order in item 13 remains in effect, the withholding provisions of this order must take effect once such benefits become payable.