Members Retirees Employers
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Notice of Death
Use this secure online form to notify SERS that a SERS member, retiree, or beneficiary has passed away.
Member or Retiree Information
1. Name: *
2. Social Security Number (last 4 digits):
3. Date of Birth:
Information about the Deceased
4. Are you reporting the death of the Member or Retiree listed above? *
5. If no, please provide the name of the deceased:
6. Relationship of the deceased to the SERS member or retiree:
7. Date of Death: *
Surviving Spouse and Children Information
8. If you are reporting the death of a retiree or member, please provide the name of the surviving spouse:
9. Please provide the number of surviving children of the member or retiree:
Contact Information
Please provide SERS with your contact information below.
10. Your name: *
11. Your relationship to the deceased:
12. Your address: (Please include city, state, and ZIP code.) *
13. Your phone number: (Please include your area code.) *
14. Your e-mail address: *