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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the deceased member’s information, including their Pension Number, Member Number, Date of Death, First Name, Middle Initial, and Last Name.
  3. Next, fill out the Releasor's Information section. Provide your First Name, Middle Initial, Last Name, Date of Birth, Address, Apartment Number (if applicable), City, State, Social Security Number, Zip Code, and Daytime Phone Number.
  4. In the statement section, clearly indicate your relationship to the deceased member. This is crucial for validating your claim.
  5. Sign and date the form at the bottom. Remember that this document must be acknowledged before a Notary Public or Commissioner of Deeds.
  6. Finally, ensure that all fields are completed accurately before submitting your form for processing.

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