Notice to Stop Social Security Payments After a Death

Date: __________

Social Security Administration
____________________________
____________________________
____________________________
[insert address where Social Security checks originate]

Name of deceased: ____________________________
Social Security number: ____________________________
Deceased's address:	___________________
___________________
Date of death: ____________________________

To whom it may concern:
This letter is to notify you of the death of the decedent. I am the representative of the decedent.
[choose one of the following]
[   ] Enclosed is the decedent's Social Security check for ___________ [date], which is being returned as required. Please cease sending checks.
[   ] The decedent's Social Security benefits were paid by direct deposit. I have notified the decedent's bank to return the funds to Social Security. Please cease depositing checks into the decedent's account.
Please acknowledge receipt of this notice by signing a duplicate of this letter and returning it to me in the enclosed stamped, self-addressed envelope.
Thank you for your assistance.

Signature: ____________________________________________________
Printed or typed name: ____________________________
Relationship to deceased: ____________________________
Address:	____________________________
____________________________
Home phone: _____________________	Work phone: ____________________

Receipt acknowledged by:
Signature: ____________________________________________________
Printed or typed name: ____________________________
Title: ____________________________