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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