Get Mo Dol Wclod-1c 2018-2025

The MO DoL WCLoD-1C form is crucial for filing a claim for line of duty compensation benefits following the death of a worker on duty. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the form online:

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by typing or writing clearly in ink where applicable. Fill in the decedent's name and social security number in the specified fields.
3. Enter the address of the decedent's Missouri residence at the time of death. If there is no Missouri address, provide the address where the decedent resided.
4. Record the date of death and the relevant employer's name and address. Ensure all information is accurate.
5. Fill in the date of injury that resulted in death, alongside the place the injury occurred.
6. Indicate the rank or title of the decedent at the time of death, and detail their marital status.
7. If applicable, provide the information for the surviving spouse, including name, address, phone number, and the last four digits of their social security number.
8. Indicate whether the decedent had children by selecting 'Yes' or 'No'.
9. Collect and attach the necessary documentation as listed, including any reports or certificates relevant to the death.
10. Complete the claimant information section with the survivor's details, including name, address, and phone number.
11. Finish filling out sections related to any guardianship claims, estate information, and additional relevant details.
12. Review all information for accuracy before printing or preparing to submit the form.
13. Finally, sign the document where indicated and ensure that it is notarized as required. You may then save changes, download, print, or share the form as needed.

Complete your documents online to ensure a smooth claims process.