Sample Letter to
^{Federal Retirement Programs}

Sample Letter D

Date

US Office of Personnel Management
Employee Service and Records Center
Boyers, PA 76017

Re: Death of Annuitant

This is to advise of the death of the following annuitant:

Name of deceased ___________________________________________________

Residence at time of death
________________________________________________________________

Date of death_____________________ Date of birth ___________________

Social Security number____________________________

CSA number_______________________________________

Eligible survivor:
_______________________________________________________________

Address of survivor:
______________________________________________________________

_______________________________________________________________

Please forward to above-named eligible survivor applications for survivor benefits, including benefits under the Federal Employees Group Life Insurance program (if decedent was covered under this program).

A certified copy of the Certificate of Death will be forwarded with each application for survivor benefits.

Sincerely,

______________________________________________
(Signature)

______________________________________________
(Relationship to Deceased)

______________________________________________
(Print Name)

______________________________________________

______________________________________________
(Print Address)

Updated April 2007 by the College Advancement Department.

Sample Letter to Federal Retirement Programs

Sample Letter D

Sample Letter to
^{Federal Retirement Programs}