The answer of the department shall be made on forms, served on the director with the mandatory benefits assignment order, substantially as follows:

IN THE SUPERIOR COURT OF THE
STATE OF WASHINGTON IN AND FOR THE
COUNTY OF . . . . . . . . . . .
. . . .	No.	. . . .
Obligee
vs.
	ANSWER TO
. . . .	MANDATORY BENEFITS
Obligor	ASSIGNMENT ORDER
. . . .
Department of Retirement Systems of
the State of Washington
1. At the time of the service of the mandatory benefits assignment order on the department, was the above-named obligor receiving periodic retirement payments from the department of retirement systems?
Yes . . . . . . No . . . . . . (check one).
2. At the time of the service of the mandatory benefits assignment order on the department, had the above-named obligor requested a withdrawal of accumulated contributions from the department?
Yes . . . . . . No . . . . . . (check one).
3. Are there any other court or administrative orders on file with the department currently in effect directing the department to withhold all or a portion of the obligor's benefits?
Yes . . . . . . No . . . . . . (check one).
4. If the answer to question one or two is yes and the department cannot comply fully with the mandatory benefits assignment order, provide an explanation.
I declare under the laws of the state of Washington that the foregoing is true and correct to the best of my knowledge.
. . . .	. . . .
Signature of director	Date and place
or	. . . .
. . . .	. . . .
Signature of person	Place
answering for director
. . . .
Connection with director