Get and Sign Building Service 32BJ Health Fund Legacy 32bjfunds Form

Participant married Names of All Spouses How Was Marriage Terminated Death Divorce Annulment Was the participant survived by any natural children or legally adopted children Yes No Name of Widow er Widow er s Social Security Widow er s Date of Birth Date of Marriage to Participant Date of Termination Please Complete Other Side Name of Child S.S. Date of Birth Address or Date of Death if applicable Name of Parent Has a court issued a document appointing an executor or administrator of the...