The answer of the department shall be made on forms, served on the director with the mandatory benefits assignment order, substantially as follows:
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.
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Signature of director
Date and place
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Signature of person
Place
answering for director
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Connection with director