RAO - MacDill Air Force Base

SURVIVOR ASSISTANCE CHECKLISTThis checklist may be used by survivors of military retirees from ALL branches of service. Your survivors mustbe prepared to furnish the following information and documents when reporting your death. Should you haveany questions please contact your Retiree Activities Office. At MacDill AFB this office is located between theCommissary and Base Exchange. Telephone number: (813) 828-4555.By completing this checklist you will save your loved ones the hardship of locating this information at the timeof your death. Remember, benefits are not paid to survivors automatically. Survivors must report the death ofthe retiree to the proper military authority as quickly as possible.Member‟s Full Name:Member‟s Social Security Number:SBP: Yes_____ No_____Member‟s Service Number:Rank:Date of Retirement:Branch or Service:Date of Birth:Place of Birth:Date of Death:Place of Death:Cause of Death:Number of Times Previously Married:(Provide marriage certificate, death certificate and/or divorce decree for each occurrence)WIDOW/WIDOWER’S INFORMATIONFull Maiden Name (If applicable):Social Security Number:Address:Telephone Number(s): Home: Cell:Date of Birth:Place of Birth:Date of Marriage:Number of Times Previously Married:Place of Marriage:**Provide marriage certificate, death certificate and/or divorce decree for each occurrence.OTHER SURVIVORSChildren – Name, Social Security Numbers, DOB, Address(Unmarried children under age 21, under age 23 if a full time student, or 21 and over but incapableof self-support)Deceased Members’ Parents (Name & Address):(If deceased, state so)Name and Address of Person Making Funeral Arrangements:Telephone Number: