We are writing to you about the Social Security checks you received for (1) .

 

If You Have Saved Any Money

You may have saved some (2) money for (3) . Any money that you have saved, plus any interest on that money, belongs to their estate.

 

What You Need To Do

You need to do one of these things:

• •

  Give this money to the legal representative of the estate,

  OR

• •

  If there is no legal representative, contact the state probate court. They will be able to tell you what to do with the money.

  OR

• •

  If there is no legal representative and you live outside the United States, contact the authorities who control the estate's money. They will be able to tell you what to do with the money.

   

If You Have Any Questions

3901C - Domestic

3901D - Foreign

Send when the payee or former payee has conserved funds for the deceased beneficiary.

 

Fill-ins:

1. (1) 

   Full name of deceased beneficiary, in the format of June Davis

2. (2) 

   Social Security, Black Lung

3. (3) 

   first name of beneficiary, if child; if adult, “Mr.” or “Ms.” last name

Use paragraph 3901D when the payee lives outside the U.S. Otherwise, use paragraph 3901C. See NL 00703.005E. for 3901C and 3901D text and fill-in.

Use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this notice will be shown on Form SSA-573.