Fidelity Advisor Transfer Due to Divorce—IRA Form Completed Form Examples and Samples
Explore real-world examples of the Fidelity Advisor Transfer Due to Divorce—IRA Form, including sample QDRO IRA transfers, alternate payee designations, Traditional and Roth IRA splits, and step-by-step completed form walkthroughs. Learn how to correctly fill out each section of the Fidelity Advisor Transfer Due to Divorce—IRA Form with detailed sample scenarios.
Fidelity Advisor Transfer Due to Divorce—IRA Form Example – QDRO IRA Transfer to Alternate Payee
How this form was filled:
This example shows how a divorcing couple completes the Fidelity Advisor Transfer Due to Divorce—IRA Form when transferring a portion of a Traditional IRA to an alternate payee spouse under a Qualified Domestic Relations Order (QDRO). The participant spouse (account owner) authorizes a 50% transfer of the IRA balance to a newly established Traditional IRA in the alternate payee spouse's name. Both parties have signed the form, a divorce decree is referenced, and the receiving Fidelity Advisor account details are provided.
Information used to fill out the document:
- Participant (Transferring) Spouse Full Name: Michael T. Harrington
- Participant Spouse Date of Birth: 03/12/1974
- Participant Spouse Social Security Number: XXX-XX-5523
- Participant Spouse Address: 4712 Oakwood Drive, Chicago, IL 60614
- Participant Spouse Phone Number: (312) 555-0187
- Participant Spouse Fidelity IRA Account Number: 702-XXXXX4821
- Type of IRA Being Transferred: Traditional IRA
- Transfer Amount: 50% of total account balance
- Alternate Payee (Receiving) Spouse Full Name: Sandra L. Harrington
- Alternate Payee Date of Birth: 07/28/1976
- Alternate Payee Social Security Number: XXX-XX-7741
- Alternate Payee Address: 890 Maple Avenue, Evanston, IL 60201
- Alternate Payee Phone Number: (847) 555-0234
- Alternate Payee Receiving Account Type: New Traditional IRA – Fidelity Advisor
- Alternate Payee Receiving Account Number: New Account to be Established
- Divorce Decree / Court Order Date: 01/14/2025
- Issuing Court: Cook County Circuit Court, Illinois
- Financial Advisor Name: Robert J. Kellerman
- Financial Advisor Branch / Rep Code: FA-774-CHI
- Participant Spouse Signature Date: 02/03/2025
- Alternate Payee Spouse Signature Date: 02/03/2025
- Medallion Signature Guarantee: Required – Provided by First National Bank of Chicago
What this filled form sample shows:
- Correctly identified participant (transferring) spouse and alternate payee (receiving) spouse with full personal details
- Clearly specified IRA type (Traditional IRA) being transferred to ensure proper tax treatment
- Transfer amount designated as 50% of total account balance in compliance with the divorce decree
- Referenced divorce decree dated January 14, 2025 from Cook County Circuit Court as the legal basis for the transfer
- Alternate payee elects to establish a new Traditional IRA at Fidelity Advisor to receive the transferred funds
- Both parties provided signatures on the same date, satisfying the joint authorization requirement
- Included Medallion Signature Guarantee from First National Bank of Chicago as required for the transfer
- Financial advisor details (Robert J. Kellerman, Rep Code FA-774-CHI) properly completed to facilitate processing
Form specifications and details:
| Use Case: | QDRO-based IRA transfer incident to divorce from participant spouse to alternate payee spouse |
| Form Name: | Fidelity Advisor Transfer Due to Divorce—IRA Form |
| Transferring Account Type: | Traditional IRA |
| Receiving Account Type: | New Traditional IRA – Fidelity Advisor |
| Transfer Method: | Percentage of total balance (50%) |
| Legal Authority: | Qualified Domestic Relations Order (QDRO) / Divorce Decree |
| Court Jurisdiction: | Cook County Circuit Court, Illinois |
| Medallion Signature Guarantee Required: | Yes |
| Both Spouse Signatures Required: | Yes |
| Supporting Documents Required: | Certified copy of divorce decree / QDRO |
| Tax Withholding on Transfer: | Not applicable – transfer incident to divorce is non-taxable event |
| New Account Required for Alternate Payee: | Yes – new Fidelity Advisor Traditional IRA |
| Financial Advisor Involvement: | Required – Rep Code and branch details must be completed |
Created: February 24, 2026 05:49 AM
