Form 25-41

Caveat: Tax consequences may result from the withdrawal of funds or other assets from an individual retirement account. Tax advice should be sought before withdrawing anything from an individual retirement account.

This form is designed to be used to assign a full or partial interest in an individual retirement account. Many brokerage firms, banks, and other financial institutions have their own forms, which should be used if available.

Assignment of Interest in Individual Retirement Account

This assignment is made in accordance with a final decree of divorce signed on [date] in Cause No. [number] in the [designation] Court of [county] County, Texas.

The Parties

The parties to this assignment are [name of person in whose name the account is titled] (“Assignor”), [name of person to whom the account was awarded in the decree] (“Assignee”), and [name of custodian of the account, such as bank or stock brokerage firm] (“Custodian”).

Assignor’s Social Security number is:

Assignee’s Social Security number is:

The Account

The individual retirement account that is the subject of this assignment is described as follows:

Name of Custodian:

Name or style on the account:

Number of the account:

The above individual retirement account was awarded to Assignee, [name of person to whom the account was awarded in the decree], by the Final Decree of Divorce. The Final Decree of Divorce ordered Assignor, [name of person in whose name the account is titled], to assign the portion of the following individual retirement account to Assignee.

Assignment

By this assignment Assignor assigns, transfers, and conveys to Assignee incident to divorce, the interest and rights described below in the individual retirement account described above.

Assignor assigns, transfers, and conveys to Assignee a portion of the assets in the account equal to [percent] percent of all assets in the account on [date of divorce]. Any increase or decrease in the account that has accrued since that date is assigned, transferred, and conveyed in the same percentage to the parties.

The following assets in the account are assigned, transferred, and conveyed by Assignor to Assignee:

Cash: $[amount]

The following stocks:

Assets in the account described as:

Assignor authorizes Assignee to take whatever actions are necessary to effectively change the name on the account from the name of Assignor to the name of Assignee, to estab­lish a new account in the name of Assignee and roll over the funds or assets into that account, or to take any other action consistent with the complete ownership of the portion of the account assigned.

Assignor authorizes a photocopy of this instrument to be used as an original.

   
[Name]

SIGNED under oath before me on ______________________________.

   
Notary Public, State of Texas

Any legal description or other information regarding the account in this document has been supplied by the client or opposing party. No independent verification or title search has been made by the law firm preparing this document.