Sf 1174 Form PDF Details

The SF 1174 form serves a critical function in providing a structured process for claiming unpaid compensation for deceased members of the uniformed services. This document is meticulously designed to ensure that the rightful beneficiaries or legal representatives can secure any earnings that were not disbursed before the service member's death. It requires detailed information regarding the claimant's relation to the deceased, their legal status, and specifics about the decedent, including their name, rank or rating, service, and social security number. Importantly, the form distinguishes between different types of claimants - from spouses and children to designated beneficiaries and legal representatives - outlining specific parts for each to complete to prevent unauthorized claims. It also probes into whether funeral expenses have been settled and by whom, emphasizing the government's intention to manage posthumous financial affairs with integrity. Embedded within the procedure are safeguards against fraudulent claims, including penalties for false statements and the necessity for witness verification of the claimant’s signature. The careful orchestration of this process underscores the combined efforts of various government agencies to afford a semblance of support to families navigating through their loss, reflecting a deep-seated respect for service members and their beneficiaries.

QuestionAnswer
Form NameSf 1174 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesstandard form 1174, sf 1174 form, form 1174 standard, form sf 1174

Form Preview Example

CLAIM FOR UNPAID COM PENSATION OF DECEASED M EM BER OF THE UNIFORM ED SERVICES

General Information: t he employing agency. deat h.

Any assist ance deemed necessary f or t he proper execut ion of t his f orm w ill be f urnished t o all claimant s by Forw ard t he complet ed f orm t o t he Government agency in w hich t he deceased w as employed at t ime of

Part A.

1 . Name(s) and social securit y

2 . Relat ionship t o deceased

3 . If minor, st at e age

number(s) of claimant (s)

 

 

 

 

 

 

 

 

 

 

 

4 . Is designat ion of benef iciary f or unpaid

 

 

compensat ion on f ile w it h service?

 

 

 

 

 

 

 

(Yes or No)

 

 

 

 

 

5 . Are you named benef iciary?

 

 

 

 

 

 

 

(Yes or No)

 

 

 

6 . Claimant (s) St at e of Legal Residence

7 . Name, rank or rat ing, service number, and

8 . Dat e of Deat h

 

social securit y number of decedent

 

 

 

 

 

 

 

 

9 . Name of Service

 

 

 

 

 

10 . Decedent ' s domicile

 

 

 

 

 

Part B (To be complet ed by t he w idow or w idow er of t he deceased only.) Do you cert if y t hat you w ere married t o t he decedent and t o t he best of your know ledge and belief t hat t he marriage w as not dissolved prior t o his/her deat h?

WIDOW OR WIDOWER AND DESIGNATED BENEFICIARIES DO NOT FILL IN PART C. ALL OTHERS M UST.

Part C

1 . List below t he name, social securit y number, age, relat ionship, and address of :

(a)Widow or w idow er.

(b)If no w idow or w idow er survives, list each living child of t he deceased (include nat ural, adopt ed, illegit imat e, and st epchildren and indicat e af t er t heir names w hich class) or t he descendant s of deceased children.

(c)If no w idow or w idow er, child or descendant of deceased children survives, list each surviving parent and st at e w het her

nat ural, st ep, f ost er, or adopt ive parent .

(d)If none of t he above survives, list t he next of kin w ho may be capable of inherit ing f rom t he deceased (brot hers, sist ers, descendant s of deceased brot hers and sist ers).

Name and Social Securit y Number

Age

Relat ionship t o

Deceased

Address

(Cont inued on ot her side)

St andard Form 1174 (EG)

Sept ember 1992

 

 

4 GAO 26 .1

 

(This f orm has been aut horized f or local reproduct ion.)

SF 1174 (Back)

Part D

1 . If none of t he above survives and an execut or or administ rat or has been appoint ed, t he f ollow ing st at ement should be complet ed:

I/w e have been duly appoint edof t he est at e of t he deceased, as evidenced by

(Execut or or administ rat or)

cert if icat e of appoint ment herew it h, administ rat ion having been t aken out in t he int erest of

(Name, address, and relat ionship of int erest ed relat ive or credit or)

and such appoint ment is st ill in f ull f orce and ef f ect .

NOTE. -- If making claim as t he execut or or administ rat or of t he est at e of t he deceased, no w it nesses are required, but a court cert if icat e evidencing your appoint ment must be submit t ed.

2 . If no administ rat or or execut or has been appoint ed, w ill one be appoint ed?

(Yes or No)

DESIGNATED BENEFICIARY, SURVIVING SPOUSE, CHILDREN, PARENTS, OR LEGAL REPRESENTATIVES DO NOT

FILL IN PART E. ALL OTHER M UST.

Part E

Have t he f uneral expenses been paid?

(Yes or No)

(If paid, receipt ed bill of t he undert aker must be at t ached heret o.)

Whose money w as used t o pay t he f uneral expenses?

FINES, PENALTIES, and FORFEITURES are imposed by law for the making of false or fraudulent

claims against the United States or the making of false statements in connection therew ith.

(Signat ure of claimant )

(Dat e)

 

(Signat ure of claimant )

(Dat e)

 

 

 

 

 

(St reet address)

 

 

(St reet address)

 

(Cit y, St at e, and ZIP code)

(Cit y, St at e, and ZIP code)

 

 

 

 

TWO WITNESSES ARE REQUIRED

We cert if y t hat w e are w ell acquaint ed w it h t he above

t he signat ure(s) of t he claimant (s) w as (w ere) af f ixed in our presence.

and t hat

(Name(s) of claimant (s))

(Signat ure of w it ness)

(St reet address)

(Signat ure of w it ness)

(St reet address)

(Cit y, St at e, and ZIP code)

(Cit y, St at e, and ZIP code)

All Federal checks in possession of the claimant, draw n to the order of the decedent, in payment of pay and allow ances should accompany this claim.

How to Edit Sf 1174 Form Online for Free

When you would like to fill out form 1174, you don't need to download any kind of software - just give a try to our online PDF editor. In order to make our editor better and simpler to work with, we constantly design new features, bearing in mind feedback coming from our users. With some simple steps, you can begin your PDF journey:

Step 1: Open the form inside our editor by pressing the "Get Form Button" in the top area of this webpage.

Step 2: As you access the editor, you will notice the document made ready to be completed. Aside from filling in various blank fields, you could also perform several other things with the form, such as adding your own words, changing the initial text, adding graphics, signing the PDF, and more.

As for the fields of this precise form, here's what you should consider:

1. First, once filling out the form 1174, start in the area that features the next fields:

deceased s form writing process described (stage 1)

2. Once your current task is complete, take the next step – fill out all of these fields - with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

this field, next field, and other fields in deceased s form

3. The third step is usually simple - fill in all the fields in Continued on other side, and Standard Form EG September GAO in order to complete this part.

Standard Form EG September GAO, Standard Form EG September GAO, and Standard Form EG September GAO in deceased s form

4. The following paragraph requires your involvement in the subsequent areas: If none of the above survives and, Iw e have been duly appointed, of the estate of the deceased as, certificate of appointment herew, Executor or administrator, and such appointment is still in, Name address and relationship of, NOTE If making claim as the, If no administrator or executor, Yes or No, DESIGNATED BENEFICIARY SURVIVING, FILL IN PART E ALL OTHER M UST, Part E, Have the funeral expenses been paid, and If paid receipted bill of the. Make sure that you fill out all needed details to go further.

NOTE If making claim as the, of the estate of the deceased as, and Yes or No of deceased s form

5. Finally, the following final portion is what you have to complete before finalizing the form. The blanks at issue are the following: claims against the United States, Signature of claimant, Date, Signature of claimant, Date, Street address, Street address, City State and ZIP code, City State and ZIP code, TWO WITNESSES ARE REQUIRED, We certify that w e are w ell, and that, the signatures of the claimants w, Names of claimants, and Signature of w itness.

Part no. 5 of filling in deceased s form

It is possible to get it wrong while completing your Street address, thus you'll want to take a second look prior to when you send it in.

Step 3: After proofreading your fields, click "Done" and you're all set! Sign up with us today and easily access form 1174, available for download. All alterations made by you are preserved , so that you can customize the document at a later time as required. We do not share or sell the details you type in while completing forms at FormsPal.

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