Please complete form online and mail completed form to: Haywood EMC 376 Grindstone Road Waynesville, NC 28785 Capital Credit Deceased Estate Claim Form Please complete form online and mail completed form to: Haywood EMC 376 Grindstone Road Waynesville, NC 28785 Capital Credit Identification Number Account Address Address Address Cont. City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Name of Deceased Date of Death Did the deceased leave a will? Yes No Name and address of Executor or Administrator Name and address of Living Spouse or Living Heirs Is the Estate still open? Yes No Please note that check will be made out to the appointed Executor or Administrator. If the estate is closed or if a will does not exist; the check will be made payable to the Clerk of Court. Date of Claim: Claimant's Signature Reset Sign above Claimant's Relationship to Deceased Claimant's Phone # Claimant's SSN To complete the claim on this account held in the name of the deceased member, you will need to provide a copy of the Death Certificate and One of the following items: Please check all applicable items, only one is required. Letters Testamentary, Letters of Administration, or Court Order (Death Certificate Enclosed) Letter referring to NCGS 28-A-25.6 - Money Owed Decedent (Appointment Notice Enclosed) CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit Leave this field blank