№ files_lp_3_process_7_054722
Official government benefits claim form submitted by a designated legal beneficiary to request payment of burial or death benefits from a state retirement system in accordance with Arkansas law.
Jurisdiction: Arkansas
Region / City: Little Rock, Arkansas
Governing Law: Act 482 of 2001
Type of Document: Official claim form
Issuing Body: Arkansas State Highway Employees’ Retirement System Board of Trustees
Purpose: Payment of burial or death benefits to designated legal beneficiary
Required Attachments: Death certificate or Proof of Death Form 19-314; Voided check for direct deposit
Tax Withholding Options: Federal Income Tax; Arkansas State Income Tax
Notarization Requirement: Signature must be notarized
Beneficiary Information Required: Full Name; Social Security Number; Mailing Address; Phone; E-Mail
Financial Details Section: Gross Benefit; Federal Withholding; State Withholding; Net Payment; Voucher Number
Administrative Fields: Prepared By; Verified By; Approved By
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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