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Funeral Statement 2006-2023
The employee's funeral.
The form must be completed, signed, and dated by the funeral home director. The funeral home director
should return the completed form directly to the Railroad Retirement Board (RRB).
This report is authorized by law (45 U.S.C. 231f(b)(6)). While you are not required to respond, failure to do so
may prevent or delay payment of benefits.
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YEAR
DAY
MONTH
1
Date of Death
+
2
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