COUNTY EMPLOYEES' AND OFFICERS' ANNUITY AND BENEFIT FUND OF COOK COUNTY AND THE FOREST PRESERVE DISTRICT EMPLOYEES' ANNUITY AND BENEFIT FUND OF COOK COUNTY

70 W. Madison St, Suite 1925, Chicago, IL 60602

(312) 603-1200

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Retirees

Death Notification Form

CCPF takes your privacy and security seriously; therefore please do not send personal or confidential information such as your bank account number or social security number through this form.

Your Information

First Name *

Last Name *

Phone Number *

Email Address *

How are you related to the decedent? *

Are you handling the affairs of the decedent?

Please provide your mailing address if you are handling the affairs of the decedent.

Decedent's Information

Name of Decedent *

Date of Death

If date of death is unknown please enter approximate date or month of death.

County / State where decedent resided at time of death

Decedent Status

Active Employee
Employee on Disability
Retiree
Spouse of Retiree

Is there a surviving spouse or a dependent child under the age of 18?

Yes
No
Unable to Confirm

Name of Spouse

Name of Dependent Child(ren)

If you have any questions, please call CCPF at (312) 603-1200.