Form Dcf F Dwsc13124 is a document that is used to report the death of an individual. The form must be completed within five days of the death, and it includes information about the deceased person, such as name, date of birth, and Social Security number. It also contains information about the person who reported the death, such as name and contact information. By completing and filing this form, you ensure that vital records are updated with information about the deceased person.
| Question | Answer |
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| Form Name | Form Dcf F Dwsc13124 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | DCF, notifications, jointly, Omitting |
DEPARTMENT OF CHILDREN AND FAMILIES
Division of Family and Economic Security
REQUEST FOR ABANDONED FUNDS
See Next Page for Instructions
Mail to:
Bureau of Child Support
P.O. Box 7935
Madison, WI
Information provided on this form (including any attachments) may be shared with others only for the purpose(s) of administration of the child support program and other related programs [Wis. Statutes, s.49.83]
The provision of your social security number is voluntary. Failure to provide your social security number may result in an information processing delay.
Payee Name of Abandoned Property |
Claimant (Your) Telephone Number |
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Social Security Number of Person Named as Payee of this Abandoned Property |
KIDS Personal Identification Number (PIN) of |
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Original Payee, if Known |
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Amount of Claim (if Known) |
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$_______________________ |
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Payee Name for the New Check |
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Address |
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State |
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Zip Code |
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Signatures Must be Notarized
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*Signature of Person Claiming Abandoned Funds. |
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Signature of other person making the claim for abandoned funds |
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if more than one person is claiming the funds. |
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Print Name |
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Print Name |
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Notarization is Required |
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Place Seal Here |
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Subscribed and affirmed to me |
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This __________ day of _______________, __________ |
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Signature of Notary Public |
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Official Use |
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State of ____________________________ |
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Fund |
Agency |
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Person Handling |
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My Commission (is permanent) _____________________ |
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Telephone Number |
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OR |
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Request Approved |
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Expires ________________________________________ |
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Yes |
No |
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Send this document to the “Mail To” address provided in the upper
*If the payee is deceased, the person making the claim on behalf of the payee’s estate should complete this form as completely as possible and attach a letter explaining that they are acting on behalf of the estate. Attach notarized copies of your appointment or authorization to act in this capacity.
INSTRUCTIONS FOR COMPLETION OF A
REQUEST FOR ABANDONED FUNDS
When completing the request form, either fill out the form online, then print and sign, or print the form and fill in the information clearly in the boxes provided. Use black or blue ink.
Payee Name of Abandoned Property
Enter the name of the person named in the Office of State Treasurer website, publications or other notifications you have received or read.
Claimant (Your) Telephone Number
Enter your telephone number here. You are the claimant. This may or may not be the person named in the Office of State Treasurer website, publications or other notifications.
Social Security Number (SSN) of Person Named as Payee of this Abandoned Property (Omitting the SSN may delay payment.)
Enter the social security number of the individual named in the Office of State Treasurer website, publications or other notifications. This may be you or someone else if you are claiming as part of an estate.
KIDS Personal Identification Number (PIN) if Known
Enter the KIDS child support system personal identification number (PIN) of the person for whom the abandoned funds were originally intended.
Payee Name for the New Check
Enter the payee name for the new check. This is whom the new check will be paid to This is generally the name and address of the person named on the Office of State Treasurer website or publication. If it is not, please attach detailed supporting documentation, including your name, address and your role/relationship in this matter.
Address, City, State, and Zip Code
Enter the address for the payee of the new check. This is where the new check will be mailed.
Signature of Person Making Claim for Abandoned Property
This is the signature of the person making the claim for abandoned property. The signature must be notarized. If it is not the person that is named in the Office of State Treasurer abandoned property website or publication, please attach an explanation and notarized copies of supporting documentation.
If more than one person, please provide the signature of the other person making a claim for Abandoned Property.
If more than one person is making the claim for abandoned property (Example: the claim is part of an estate that is jointly administered), please provide the signature of the other person(s) here. Signature(s) must also be notarized.
If the form is not properly notarized, it cannot be processed.
If the person making this claim is acting on behalf of the payee’s estate, then you must attach notarized copies of your authorization to act in this capacity.
If you have any questions regarding this form, please call the Bureau of Child Support at (608)
DCF is an equal opportunity employer and service provider. If you have a disability and need to access this information in an alternate format, or need it translated to another language, please contact (608)