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- Click ‘Get Form’ to open the Probate Claims Notice in the editor.
- Begin by entering the name of the deceased member and their Social Security Number (SSN) in the designated fields. Ensure accuracy as this information is crucial for identification.
- Select the type of probate and fill in the date of death, date of birth, and file number. These details help establish the timeline and context of the estate.
- Indicate if the deceased received any Medicaid or related benefits by checking the appropriate boxes. This section is vital for compliance with state regulations.
- If applicable, provide information about a predeceased spouse, including their name, SSN, date of birth, and date of death. Attach additional sheets if necessary.
- Complete your personal details as the representative or petitioner, including mailing addresses for both you and your attorney.
- Finally, ensure that you send this form via certified mail to the Department of Health Services Estate Recovery Section at least 30 days prior to any relevant deadlines.
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