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This version of the form is not currently in use and is provided for reference only. Download this version of
State Form 55761
for the current year.
State Form 55761 Claim for State Employee Line of Duty Death Benefit for a Spouse, or Dependent Child as Beneficiary - Indiana
What Is State Form 55761?
This is a legal form that was released by the Indiana Public Retirement System - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 55761?
A: Form 55761 is the claim form for the State Employee Line of Duty Death Benefit for a Spouse or Dependent Child as a beneficiary in Indiana.
Q: Who can use Form 55761?
A: This form is used by the spouse or dependent child of a state employee who died in the line of duty.
Q: What is the purpose of Form 55761?
A: The purpose of this form is to apply for the State Employee Line of Duty Death Benefit in Indiana.
Q: Are there any documentation requirements for Form 55761?
A: Yes, you will need to provide supporting documents such as a death certificate and proof of relationship with the deceased state employee.
Form Details:
- Released on March 1, 2021;
- The latest edition provided by the Indiana Public Retirement System;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of State Form 55761 by clicking the link below or browse more documents and templates provided by the Indiana Public Retirement System.
Download State Form 55761 Claim for State Employee Line of Duty Death Benefit for a Spouse, or Dependent Child as Beneficiary - Indiana
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