Notice firefighter form 2026

1. Click ‘Get Form’ to open the notice firefighter form in the editor.
2. Begin by filling in the 'To' section with the name and title of the officer responsible for receiving this notice.
3. Provide the political subdivision liable for benefits, including their home address and apartment number if applicable.
4. In section 1, enter the volunteer firefighter's name and address. Ensure all details are accurate.
5. Complete sections 2 through 4 by providing information about the fire company, political subdivision or fire district, and regular employer if any.
6. In section 5, describe where the injury occurred in detail.
7. Fill out section 6 with the date and time of injury or death, along with the place of death if applicable.
8. Finally, state fully the nature and cause of injury or death in section 7 before signing at the bottom. If signed by someone on behalf of the firefighter, include their relationship.

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