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	PENSION CHECKLIST FOR DIVORCE ALLOCATION ONLY

Attorney Data:

1. What is attorney name?
2. What is the firm name?
3. What is attorney address?
4. Is attorney representing participant or spouse?

1. What is the participant’s name?
2. What is the participant’s address?
3. What is the participant’s sex?
4. What is the participant’s date of birth?
5. What is the participant’s date of marriage?
6. What is the participant’s date of divorce or separation?

1. What is the pension plan name?
2. What is the participants date of hire?
3. Is participant currently receiving benefits or is terminated from this plan?
   
   If no to question 3, please go to question 8:
   

4. If receiving benefits, please provide documentation of commencement date
5. If terminated please provide the termination date and the age of deferred benefit commencement
6. What is the monthly benefit amount?
7. What is the annuity form (i.e. life annuity, joint and 50% survivor, etc.)

   If no to question 3:
   

8. Please provide the most recent accrued benefit statement received, the plan booklet, summary plan description and any other documentation of pension plan provisions available.

Please include a check for $250 payable to Sheldon Wishnick, FSA with your responses to the information requested. Please call if any questions arise while completing form.