Sample Letter to PERS

Sample Letter B

Date

PERS
PO Box 23700
Tigard, OR 97281-3700

Attention: Death Benefits

The enclosed copy of a death certificate is for,
_________________________________________________________________
(Name of deceased),

Social Security number _______________________________________,

who died _____________________________________.(Date of death)

Since he (she) has had his (her) checks direct deposited to
__________________________________________________________________
(Bank/Financial Institution)

in ___________________________________________________________,
(City, State Zip)

I have asked the bank to return any future checks which it receives. I have notified your office by phone of this death.

Sincerely,

________________________________________________
(Signature)

________________________________________________
(Type or Print Name)

________________________________________________

________________________________________________
(Type or Print Address)

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