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Complete and submit this form to claim an unpaid survivor annuity payment. This form is valid only for survivors of Police Officers or Firefighters who were enrolled in the Plan.
In accordance with D.C. Code §§5-716(e)(1), 5-716(e)(2), and 5-723(a), survivor annuity payments of deceased survivor annuitants are to be prorated for the number of days the deceased survivor had lived during the month and are to be paid under the order of precedence set forth in D.C. Code §5-723(d)