Bereavement Support

First name

Last name

Email

Address

AFGE Membership Number

Full Name of the Deceased:

Relationship:

Spouse

Child

Parent

Verification

Obituary, Funeral Program, Death Notice, or Other documentation verifying the passing

I certify that the information provided is true and accurate to the best of my knowledge. I understand AFGE Local 2280 may request additional documentation to verify eligibility for bereavement support.