NYSTRS.ORG - Domestic Relations Order

NYSTRS
Domestic Relations Order Form

Domestic Relations Order

Overview

Instructions

DRO Form

Draft a Domestic Relations Order (DRO)

TYPE OF DOCUMENT

Is this a new DRO or are you changing the terms of an existing DRO that has already been signed by a judge?

New Domestic Relations Order
Amended Domestic Relations Order *

If amending a DRO previously filed with NYSTRS, please complete the information below.

Date the original DRO was granted	*
Name of the Granting Judge	* * *
Court of Jurisdiction	* * *

PARTICIPANT (MEMBER) INFORMATION

First Name	* * *
Middle Initial	(optional) * *
Last Name	* * *
Suffix	(i.e., Jr., Sr., I, II, or III) * *
Date of Birth	*
Social Security Number
Tier of Membership (See chart)	* *

Employment Status:
Active
Retired *

If Participant is currently retired from NYSTRS, please enter the retirement date below.

Date of Retirement

PARTICIPANT ADDRESS

Participant is currently a resident of the United States.

Street Address	(i.e., 1 Park Ave.)
Street Address 2	(i.e., Apt. A)
City	(i.e., Albany) * * *
State	*
Zip Code	(i.e., 12345 or 12345-6789) * * *

* * * * *

Participant is not currently a resident of the United States. *

Country of Residence	* *
Address	* * *

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