Military Order Form

Petitioner Information

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Social Security Number

Date of Birth

Email Address *

Respondent Information

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Social Security Number

Date of Birth

Date of Marriage

Date of Division

Significant Date of Division

Case Information

Judge's First Name

Judge's Last Name

County

State of Action

Case Number

Name of Plan Participant

Precise Name of Plan

Percentage / Dollar Amount of Award

Branch of Military Member has served / is serving in:

Date of Entry into Service

ActiveRetired

Status of Service

Date of Separation From Service

YesNo

Is Member currently receiving military retired pay?

Please Indicate Amount

YesNo

Were parties married?

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Military Order Form

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Bonita Springs, FL

Washington, D.C.

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