Qildrovchilar Form – Fill Out and Use This PDF

Instructions for QILDRO Calculation Court Order

Please follow these instructions for completing the QILDRO Calculation Court

Order form on the following page. Do not alter the form. Doing so will invalidate the order.

This form is required only if the QILDRO requires payment of any benefit to be calculated using the marital portion benefit calculation formula or a percentage of gross benefit.

Caption:

•Enter court's judicial district and county. The issuing court must be an Illinois court.

•Enter the case caption and case number.

Section 2:

•Enter the name, mailing address and social security number of the member and of the alternate payee.

•Stipulate the alternate payee's relationship to the member.

Sections 3 and 4:

If the court orders this		…then the following subsection of the
benefit in the QILDRO…		QILDRO Calculation Order must be completed
		Section 3 –	Section 4 –
QILDRO Section:		% of Marital Portion	% of Gross Benefit
III –	Monthly Annuity	3a	4a
V –	Full Refund	3b	4b
VI –	Partial Refund	3c	4c
VII – Death Benefit		3d	4d

Signature Lines: The QILDRO Calculation Order must be signed and dated by the issuing judge.

Instructionstructions:QILDROConsentCalc Orderto Issuance Pageof QILDRO1 of 1

IN THE CIRCUIT COURT OF THE ________________________________ JUDICIAL DISTRICT

_____________________________________________________________ COUNTY, ILLINOIS

)

	Petitioner	)	No. _______________
vs.		)

Respondent )

QILDRO Calculation Court Order

Illinois Municipal Retirement Fund

THIS CAUSE coming before the Court for the purpose of the entry of a QILDRO Calculation Court Order under the provisions of Section 1-119 of the Illinois Pension Code (40 ILCS 5/1-119), the Court having jurisdiction over the parties and the subject matter hereof; the Court finding that a QILDRO has previously been entered in this matter, that the QILDRO has been received and accepted by the Retirement System, and that the QILDRO requires percentage calculations to allocate the alternate payee's share of the member's benefit or refund, the Court not having found that the QILDRO has become void or invalid, and the Court being fully advised;

IT IS HEREBY ORDERED AS FOLLOWS:

(1)The definitions and other provisions of Section 1-119 of the Illinois Pension Code (40 ILCS 5/1-119) are adopted by reference and made part of this Order.

(2)Identification of Retirement System and parties:

Retirement System: Illinois Municipal Retirement Fund

2211 York Dr., Suite 500

Oak Brook, IL 60523-2337

Member: ___________________________________________________

(Name)

___________________________________________________

(Mailing address)

___________________________________________________

(Social Security Number)

Alternate Payee: ___________________________________________________

(Name)

___________________________________________________

(Mailing Address)

___________________________________________________

(Social Security Number)

The Alternate payee is the member’s (check one):

current or former spouse		current or former civil union partner			child or other dependent.
			Instructions: QILDRO Calculation Court Order
Member Name _______________________________ QILDRO : Calc Order						Page 1 of 3

(b) The alternate payee's benefit pursuant to QILDRO Section V(A)(3) shall be calculated and paid as follows:

(____________________________) X __________________ = ______________________________

(Gross Benefit Amount)

(Percentage)

(Amount)

(c) The alternate payee's benefit pursuant to QILDRO Section VI(A)(3) shall be calculated and paid as follows:

(____________________________) X __________________ = ______________________________

(Gross Benefit Amount)

(Percentage)

(Amount)

(d) The alternate payee's benefit pursuant to QILDRO Section VII(A)(3) shall be calculated and paid as follows:

(____________________________) X __________________ = ______________________________

(Gross Benefit Amount)

(Percentage)

(Amount)

The Retirement System's sole obligation with respect to the equations in this paragraph (4) is to pay the amounts indicated as the result of the equations. The Retirement System shall have no obligation to review or verify the equations or to assist in the calculations used to determine such amounts.

(5)The Court retains jurisdiction over this matter for the following purposes:

(A)To establish or maintain this Order as a QILDRO Calculation Court Order;

(B)To enter amended QILDROs and QILDRO Calculation Court Orders to conform to the parties’ QILDRO, Marital Settlement Agreement or Agreement for Legal Separation ("Agreement"), to the parties' Judgment for Dissolution of Marriage or Civil Union or Judgment for Legal Separation ("Judgment"), to any modifications of the parties’ QILDRO, Agreement, or Judgment, or to any supplemental orders entered to clarify the parties' QILDRO, Agreement, or Judgment; and

(C)To enter supplemental orders to clarify the intent of the parties or the Court regarding the benefits allocated herein in accordance with the parties' Agreement or Judgment, with any modifications of the parties' Agreement or Judgment, or with any supplemental orders entered to clarify the parties' Agreement or Judgment. A supplemental order may not require the Retirement System to take any action not permitted under Illinois law or the Retirement System's administrative rules. To the extent the supplemental order does not conform to Illinois law or administrative rule, it shall not be binding upon the Retirement System.

DATED: __________________________________________
SIGNED: __________________________________________
(Judge's Signature)
Instructions: QILDRO Calculation Court Order
Member Name _______________________________ QILDRO : Calc Order	Page 3 of 3