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Office of the New York State Comptroller’s Seal

NYS Comptroller

Thomas P. DiNapoli

NYSLRS Report a Death Form

Use this form to report the death of a NYSLRS member or retiree. This information will be sent over a secure connection.

* Indicates a required field

Your Information

Report a Death

Deceased Person’s Information

Please provide any known information for the deceased person.

If you don’t know the NYSLRS ID, enter the registration number or retirement number, or you can enter the last four digits of the deceased person’s Social Security Number (if known) in the next field.

Other Information

NYSLRS will need an original death certificate or certified copy before we can pay any death benefits.

NYSLRS will need an original death certificate or certified copy before we can pay any death benefits (all original documents will be returned). Mail the death certificate (we suggest certified mail — return receipt requested) to:

NYSLRS

110 State St

Albany, NY 12244-0001

You can attach a copy of the death certificate to this email form now so that we can begin identifying any benefits that may be payable.

Note: This form only accepts PDF, JPG, PNG and GIF file types. Maximum file size is 5 MB.

Additional Contact Information

If the deceased has a surviving spouse or other close living relative, please provide their contact information.