District Court _________________________ County, Court Address: In re The Marriage of: The Civil Union of: Petitioner: ______________________________________ COURT USE ONLY Case Number: Division Co-Petitioner or Respondent:__________________________ Courtroom DOMESTIC RELATIONS ORDER FOR A PERA BENEFIT PLAN MODIFICATION OF A PRIOR DOMESIC RELATIONS ORDER FOR A PERA BENEFIT PLAN This matter comes before the Court for approval upon: An agreement for a Domestic Relations Order concerning a PERA Benefit Plan (the "Agreement") attached hereto. An agreement for a Domestic Relations Order concerning Modification of a Prior Domestic Relations Order for a Benefit Plan (the "Agreement") attached hereto. The Court having reviewed and considered the Agreement and being fully advised in the premises, the Court hereby makes the following findings: 1. The Court has jurisdiction over both parties to this order, and the parties have consented to the entry of this Order. 2. The Courts finds the Agreement, which is attached hereto and incorporated into this Order, has been signed by both parties and entered into by them pursuant to §14-10-113(6), C.R.S. 3. The Court further finds that the parties have entered into this Agreement voluntarily and knowingly, and that the Agreement is reasonable and not unconscionable. The Court therefore Orders: that the attached Agreement be and hereby is approved and adopted and incorporated into the Decree and Permanent Orders entered by the Court in the parties' Dissolution of Marriage, Dissolution of Civil Union, Legal Separation (Marriage or Civil Union) or Invalidity of Marriage or Civil Union, as if fully set forth herein. that the Agreement be and hereby is approved and adopted and the prior Domestic Relation Order for a PERA Benefit Plan previously entered in this matter be and hereby is modified accordingly. Date: ________________________________ ______________________________________ Judge Magistrate JDF 1202 R7/13 DOMESTIC RELATIONS ORDER FOR A PERA BENEFIT PLAN ­ ORIGINAL OR MODIFIED © 2013 Colorado Judicial Department for use in the Courts of Colorado American LegalNet, Inc. www.FormsWorkFlow.com