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.
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Completed Fidelity Advisor Transfer Due to Divorce IRA Form showing a QDRO-based IRA transfer from a participant spouse to an alternate payee spouse

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
Categories: divorce forms, IRA forms, Fidelity forms, transfer forms
Created: February 24, 2026 05:49 AM
Completed Fidelity Advisor Transfer Due to Divorce IRA Form showing a QDRO-based IRA transfer from a participant spouse to an alternate payee spouse