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The document is a beneficiary verification form for the Kodak Retired Employees Beneficiary Association (KREBA), detailing the process for survivors to claim survivor income benefits (SIB) after the death of a SIB participant. It outlines required information about the deceased and their beneficiaries, including surviving spouses, dependent children, and dependent parents, along with necessary documentation such as death and birth certificates. The document also defines eligibility criteria for each type of beneficiary and provides contact information for further inquiries.

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