The answer of the department shall be made on forms, served on the director with the mandatory benefits assignment order, substantially as follows: 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
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