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 | ||