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Get Lump Sum Death Benefit Application - State Of Alaska - Doa Alaska

/drb Check One: PERS TRS NGNMRS EPORS Juneau: 465-4460 TDD: (907) 465-2805 Fax: (907) 465-3086 JRS SECTION I PERSONAL DATA BENEFICIARY NAME (Last, First) DATE OF BIRTH SOCIAL SECURITY NUMBER MAILING ADDRESS (Street or P.O. Box, City, State, ZIP) for payment and 1099-R TELEPHONE NUMBER ( ) DECEASED NAME SOCIAL SECURITY NUMBER OF DECEASED DATE OF DEATH RELATIONSHIP TO DECEASED SECTION II DEATH BENEFIT DISTRIBUTION As a benef.

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