Get Form 19b - Ok.gov

Filling out Form 19B is a straightforward process that allows you to submit a qualified disclaimer for death benefits related to a deceased firefighter. This guide will provide you with clear, step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to complete your Form 19B.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. In the first section, provide the deceased member's social security number (SSN) accurately.
3. Enter the name of the fire department associated with the deceased.
4. In the next field, print your full name as the applicant.
5. State your relationship to the deceased firefighter in the designated area.
6. Clearly indicate the full name of the deceased firefighter in the corresponding space.
7. Write the name of the entity or person that will receive the death benefit, which may include those providing funeral and burial services.
8. Review the wording of the disclaimer to confirm it reflects your intent to disclaim rights to the death benefit.
9. Provide your signature as the applicant and ensure you write the date of signing.
10. Fill in your mailing address, city, state, and zip code accurately.
11. Record your phone number in the provided space for contact purposes.
12. Complete the notary section by signing in the presence of a notary public, who must then fill in their details and sign.
13. Once all sections are completed, save your changes, and download or print the form for your records or submission.

Complete your Form 19B online to ensure a timely processing of your disclaimer.