Transfer Due to Divorce — IRA/HSA/529 Completed Form Examples and Samples
Browse real-world examples of completed Transfer Due to Divorce forms for IRA, HSA, and 529 accounts. Each sample shows how to correctly fill out transferor and transferee details, specify transfer amounts, reference court orders, and satisfy QDRO requirements — helping you avoid costly mistakes during a divorce asset transfer.
Transfer Due to Divorce — IRA/HSA/529 Example – Traditional IRA Transfer to Spouse
How this form was filled:
This example shows a Traditional IRA divorce transfer where the account holder (transferor) assigns a portion of their IRA assets to their former spouse (transferee) as directed by a Qualified Domestic Relations Order (QDRO). The transferring account number, the receiving institution details, and the exact dollar amount being transferred are all clearly specified. Both parties' information is completed, and the form is signed and dated in 2025.
Information used to fill out the document:
- Transferor (Current Account Holder) Full Name: Michael R. Henderson
- Transferor Date of Birth: 03/12/1978
- Transferor Social Security Number: XXX-XX-4821
- Transferor Address: 4820 Oakwood Drive, Austin, TX 78701
- Transferor Phone Number: (512) 555-0193
- Transferor Account Number: VG-IRA-00847263
- Transferring Institution Name: Vanguard Financial Services
- Transferring Institution Address: 100 Vanguard Blvd, Malvern, PA 19355
- Account Type: Traditional IRA
- Transfer Amount: $42,500.00
- Transfer Type: Partial Transfer (50% of account balance)
- Divorce Decree / Court Order Date: 01/14/2025
- Transferee (Former Spouse) Full Name: Laura J. Henderson
- Transferee Date of Birth: 07/28/1980
- Transferee Social Security Number: XXX-XX-3397
- Transferee Address: 215 Riverbend Lane, Austin, TX 78702
- Transferee Phone Number: (512) 555-0247
- Transferee Receiving Account Number: FID-IRA-00612894
- Receiving Institution Name: Fidelity Investments
- Receiving Institution Address: 245 Summer Street, Boston, MA 02210
- Transferor Signature: Michael R. Henderson
- Transferor Signature Date: 02/03/2025
- Transferee Signature: Laura J. Henderson
- Transferee Signature Date: 02/05/2025
- Authorized Plan Representative Signature: Sandra K. Briggs
- Representative Signature Date: 02/07/2025
What this filled form sample shows:
- Clearly identified transferor and transferee with full personal details including date of birth and SSN
- Correct account type selection — Traditional IRA — distinguished from HSA or 529 plan options
- Specified partial transfer amount of $42,500.00 representing 50% of the total IRA balance per the divorce decree
- Divorce decree court order date of January 14, 2025 provided as legal basis for the transfer
- Complete transferring and receiving institution details including account numbers for both Vanguard and Fidelity
- All three required signatures obtained: transferor, transferee, and authorized plan representative
- Transfer complies with QDRO (Qualified Domestic Relations Order) requirements to avoid early withdrawal penalties and tax consequences
Form specifications and details:
| Use Case: | Traditional IRA partial transfer to former spouse pursuant to divorce decree |
| Account Type: | Traditional IRA |
| Transfer Trigger: | Divorce / Court Order (QDRO) |
| Transfer Method: | Direct institution-to-institution transfer |
| Transfer Scope: | Partial (50% of account balance) |
| Transferring Institution: | Vanguard Financial Services |
| Receiving Institution: | Fidelity Investments |
| Governing Document: | Qualified Domestic Relations Order (QDRO) dated 01/14/2025 |
| Tax Consequence: | None — transfer is tax-free when processed as a direct trustee-to-trustee transfer per IRC Section 408(d)(6) |
| Early Withdrawal Penalty: | Not applicable — divorce-related IRA transfers are exempt when properly executed |
| Signatures Required: | Transferor, Transferee, Authorized Plan Representative |
| Form Relevance: | Applicable to IRA, HSA, and 529 account divorce transfers |
Created: February 24, 2026 04:03 AM
