SSA-721: Social Security Statement of Death By Funeral Director

Form SSA-721 PDF Details

Please complete the required fields (*) below.

Survivors: please give pages 2 and 3 of this form to any survivors of the deceased.

Social Security Number: if SSN unknown, please contact local SSA office to report death.

Death: date of death and city/state/country of death (where death occurred).

Surviving spouse and children, names: name of Surviving Spouse and names of any minor or disabled adult children (if known).

Surviving spouse and children, SSN: Surviving Spouse SSN and SSN of any minor or disabled adult children (if known).