In the complex landscape of retirement systems and beneficiary procedures, the TRSNYC DB28 form stands as a critical document for those navigating the aftermath of a TRS member's passing. This form, known as the Release of Claim Form under Section 1310, serves as a legal instrument enabling individuals to claim due sums from the Teachers' Retirement System (TRS) on behalf of deceased members. The meticulous design of the form ensures that all necessary information is captured, starting with basic identification details of the claimant such as name, social security number (last four digits), and contact information, thereby safeguarding against errors that could delay processing. Furthermore, it emphasizes the importance of accurate, permanent address records, advising against temporary addresses and urging claimants to maintain updated records with TRS. At its core, the form entails a declaration by the claimant, outlining their relationship to the deceased, the consent to collect a specified sum, and a commitment not to hold TRS or any associated parties liable for the payment of this amount. Completion and signing of the form must be witnessed by a notary, underscoring the legal weight of the document and ensuring its veracity through official attestation. Thus, the DB28 form represents a bridge between the bereaved and the benefits their loved ones have left behind, encapsulated in a structured process that respects both the legal framework and the personal sensitivities of the situation.
| Question | Answer |
|---|---|
| Form Name | Trsnyc Form Db28 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | DB28 db28 form trs |
RELEASE OF CLAIM FORM
UNDER SECTION 1310
(NOTE: Please print in black or blue ink, and initial any changes that you make on this form.)
PART A: All information must be provided.
First Name |
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MI Last Name |
Social Security Number (last 4 digits only) |
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Permanent Home Address |
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Apt. No. |
Primary Phone Number (Check one: Home Work Mobile) |
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City |
State Zip Code |
Alternate Phone Number (Check one: |
Home
Work
Mobile)
( )
Please keep your personal information with TRS up to date. We will update our records based on the information you provide above, so do not enter a temporary address; instead, TRS suggests that you consult the U.S. Postal Service about having your mail forwarded on a temporary basis. To register any changes to your permanent address (and/or phone number), please access our website or file a “Beneficiary’s Change of Address Form” (code DM14) with TRS.
If you are providing new information above, please indicate the effective date:
PART B: Please print all information below, and sign and date this form.
I, ____________________________________________ state that I am the _____________________ of _______________________
(relation to deceased)(name of deceased)
__________________________________ , a member of TRS with membership number ________________________ . I consent to the
collection by ________________________________________________________ of the sum of $ ____________________________
due from TRS. I further agree not to hold TRS, the Teachers’ Retirement Board, or any of its members, individually or collectively, liable
at any time for payment of this sum to the
SIGNATURE ________________________________________________________ |
DATE (M/D/Y) _________________________ |
DB28 (6/10) |
CONTINUED ON PAGE 2 |
PAGE 1 |
CONTINUED FROM PAGE 1
PART C: TO BE COMPLETED BY A NOTARY (NOTE: Attestation made outside the U.S. must be executed before an American consul.)
State of ____________________________ )
)s.s.:
County of __________________________ )
On the _____________ day of _________________, __________, before me personally appeared the person known to me
to be __________________________________________________________ , the individual who executed the foregoing
instrument and acknowledged to me that (s)he executed the same.
Signature: _____________________________________________________
Official Title: ____________________________________________________
Expiration Date of Commission: ____________________________________
DB28 (6/10) |
PAGE 2 |
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