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 |