Civil Service Benefit— Active Employee

1. Provide the case number and the county/district in which the matter will be heard.
   

   Case #
   County

2. Name of the party whose benefits are to be divided by an Order:
   
3. Provide the following regarding the Husband:
   

   Name of Husband
   Is he the Plaintiff / Petitioner or Defendant / Respondent?	Husband is Plaintiff Husband is Defendant
   Date of birth
   Social Security Number
   Home Address



4. Provide the following regarding the Wife:
   

   Name of Wife
   Date of birth
   Social Security Number
   Home Address

   
   
5. Date of marriage:
   
6. Jurisdiction's end of marriage date (cutoff date to be used for acquisition of marital assets), i.e. date of separation, filing of the complaint, service of summons, etc.
   
7. Advise the Service Computation Date for the party in the Retirement System:
   
8. Is this Order being drafted for both parties on behalf of both attorneys, or is it being drafted exclusively on behalf of Plaintiff/Petitioner or Defendant/Respondent?
   

   Both Parties/Both Attorneys

   Plaintiff/Petitioner

   Defendant/Respondent

   
   
9. Advise the full name, address, phone number, fax number and e-mail address of the attorney for the Plaintiff/Petitioner. If the Plaintiff/Petitioner is Pro Se just specify Pro Se below.
   

   Name and Address:
   Phone number:
   Fax Number:
   E-mail address:

   
   
10. Advise the full name, address, phone number, fax number and e-mail address of the attorney for the Defendant/Respondent. If the Defendant/Respondent is Pro Se just specify Pro Se below
    

    Name and Address:
    Phone number:
    Fax Number:
    E-mail address:

    
    
11. Advise the full name and address of the employer for the party whose benefits are to be divided. If more than one employer involved provide complete details on all.
    
12. If this is a Florida matter provide the city and county for the trial.
    

    City
    County

13. Is the party whose benefit is to be divided still actively employed?
    Yes      No
    If the party is terminated or retired and collecting provide the date of termination or retirement:
    
    IF THIS QUESTION IS NOT ANSWERED WE WILL ASSUME THE INDIVIDUAL IS STILL ACTIVELY EMPLOYED.

In addition to the data requested above we also require the following documents:

You can provide this documentation to us by U. S. Mail or Facsimile to:
Troyan Inc.
1133 Bal Harbor Boulevard, Suite 1147
Punta Gorda, Florida 33950
Fax: 941-505-4040

14. Provide a copy of the settlement agreement or a delineation of same. Also specify the exact sections or pages of the Agreement we are to review regarding the Order(s).
15. Provide a copy of the Judgment of Divorce. If there will not be a divorce advise us.
16. Obtain an estimate from the Retirement System which provides the party's date of hire, service computation date, credited service and accrued benefit as of the applicable cut off date, which would be payable at normal retirement age.
    
    If this is not available then provide the party's highest three year average salary as of the applicable cut off date in this matter, the party's total credited service as of the cut off date and the party's service computation date.
17. If we are to draft against the Thrift Savings Plan for this individual, provide a copy of the statement provided to the employee as close as possible to the cut off date, current date and the date of marriage (if available).
18. Provide a copy of any underlying report prepared for this matter.
19. If the party is retired and collecting provide a copy of the benefit calculation provided to the individual at retirement including information on the amount of any survivor annuity elected at retirement and the beneficiary named, if any. This should also include the party's date of hire, service computation date, credited service, date of termination and any other data used to make the calculation.

Credit Card & Billing Information

For Attorneys: The below credit card will be charged $500.00 per Order to be prepared.

For Non Attorneys: The below credit card will be charged $650.00 per Order to be prepared.

If you have any questions regarding the appropriate amount to be charged you may contact a technician at 1-877-443-4867 and we will assist you. The completed Order(s) will be sent from our office by regular mail.

Before submitting this data to us please double check all of the information you have entered to make sure it is correct.