Get Affidavit Of No Records

The Affidavit Of No Records is a crucial document often required for individuals who have discontinued their county service and need to provide evidence regarding their medical history. This guide will help you navigate through the process of filling out this affidavit online in a clear and structured manner.

Follow the steps to successfully complete the affidavit form online.

1. Click the ‘Get Form’ button to access the Affidavit Of No Records and open it in your online editor.
2. Fill in your member name at the top of the form in the designated space provided.
3. Next, enter your employee ID number in the specified field to help identify your records.
4. Check the appropriate box to indicate how you discontinued county service. You may select 'Service Retirement', 'Termination', or 'Resignation'.
5. Provide the date you submitted your Application for Disability Retirement to LACERA in the designated space.
6. Indicate the date when the application was returned to you as incomplete.
7. If applicable, specify your safety member status and the presumption under which you are seeking disability retirement.
8. Complete the following statements by checking the boxes that apply to your situation regarding medical treatment and documentation.
9. In the provided space, explain the reasons for not having the required documents and detail your efforts to obtain them.
10. After completing all sections, review the affidavit for accuracy. Sign and date the form at the bottom to confirm the truthfulness of your statements.
11. Finally, save your changes, download a copy of the form, print it, or share it as needed.

Complete and file your Affidavit Of No Records online today for a streamlined process.