1 Any Attorney or Party

Any Street
2 Any Town, CA 55555

3 714-555-5555

4 Any Attorney or Party

8 Superior Court of the State of California

9 For the County of ___________________

10

11 In re the marriage of: ) Case No.

)
12 ) QUALIFIED DOMESTIC RELATIONS ORDER
) RE: CHILD SUPPORT, SPOUSAL OR FAMILY
13 Petitioner, ) SUPPORT
)
14 and )
)
15 Respondent. )
)
16 )
)
17

18 To subscribe to my FREE weekly legal newsletter visit

19
http://legaldocspro.net/newsletter.htm and enter your e-mail address.
20

21 Do NOT just use the wording in this sample unless it definitely fits your
22

23
particular situation.
24

25
To view more information on a divorce litigation document
26
package sold by LegalDocsPro with over 45 sample documents selling
27

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 1 at a huge discount visit: http://legaldocspro.net/california-divorce-
2

3
litigation-document-package/
4

5
Be sure to remove this notice and all other notices before using
6
this document.
7

8
TO THE PAYOR/PLAN LIST NAME OF PAYOR OR PLAN HERE.
9

10 PLEASE TAKE NOTICE: That this is an earnings assignment order for support governed by

11 Chapter 8 of the Family Code and is intended to be a qualified domestic relations order (QDRO)
12
under applicable federal law. This order applies to the following named plan:
13

14 Name: LIST NAME OF PAYOR OR PLAN HERE

15
Address: LIST COMPLETE ADDRESS OF PAYOR OR PLAN HERE
16

17 This order requires you to withhold a portion of the benefits payable under the Plan with
18
respect to
19

20 Name: LIST FULL NAME OF THE PARTICIPANT IN THE PLAN HERE

21
Address: LIST COMPLETE ADDRESS OF PARTICIPANT IN THE PLAN HERE
22

23 DOB: LIST DATE OF BIRTH OF PARTICIPANT HERE

24

25 ID#: LIST THE EMPLOYEE IDENTIFICATION NUMBER OF EMPLOYEE HERE

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and pay as directed below.
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 1 NOTE THAT YOU MUST SERVE A SEPARATE ATTACHMENT TO THIS
2 QUALIFIED DOMESTIC RELATIONS ORDER FOR SUPPORT THAT IS NOT FILED
3
WITH THE COURT THAT SPECIFIES THE SOCIAL SECURITY NUMBER OF ANY
4
PARTICIPAN NAMED ABOVE AND SERVE IT ON THE PLAN WITH A COPY OF THIS
5

6
ORDER. DO NOT FILE A COPY OF THE ATTACHMENT WITH THE COURT. THERE IS

7 A SAMPLE ATTACHMENT IN THIS SAMPLE LOCATED AT PAGES 13 THROUGH 14.

8
THE COURT ORDERS THE FOLLOWING:
9

10 1. WITHHOLDING OF PERIODIC BENEFIT PAYMENTS:

11

12 a. If Participant has commenced receiving benefits under the Plan in the form of monthly

13 or other periodic payments or has applied to receive monthly or other periodic payments (if benefits
14 are not in pay status and have not been applied for, see item 5; if benefits are payable in a lump sum,
15
see item 3), withhold the following amounts from the monthly benefits otherwise payable to the
16
Participant:
17

18
(1) $LIST MONTHLY AMOUNT OF CURRENT CHILD SUPPORT
19

20 To purchase the entire 15 page document visit:

21

22
https://legaldocspro.myshopify.com/products/sample-qualified-
23

24 domestic-relations-order-for-support-in-california
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