Indiana
Claim to Defray Funeral and Cemetery Expenses SF 35937
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Source / last checked DFR: Forms - 2026-11-02
- Form number
- 35937
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Claim to Defray Funeral and Cemetery Expenses SF 35937
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Program
- Burial Assistance Office
Claim to Defray Funeral and Cemetery Expenses SF 35937 - Reviewed 2026-11-02
- Jurisdiction
- Indiana
DFR: Forms - Reviewed 2026-11-02
- Category
- FUNERAL AND CEMETERY EXPENSES
Claim to Defray Funeral and Cemetery Expenses SF 35937 - Reviewed 2026-11-02
- Form type
- form
DFR: Forms - Reviewed 2026-11-02
- Who fills it out
- Claimant must complete, sign and date form. Submit to Family and Social Services Administration (FSSA), Division of Family Resources (DFR), within ninety (90) days of date of death. Instructions on how to complete and submit form are on page 2.
Claim to Defray Funeral and Cemetery Expenses SF 35937 - Reviewed 2026-11-02
- How to submit
- Submit claims by either fax or e-mail to the Burial Assistance Office; see contact information below.
Claim to Defray Funeral and Cemetery Expenses SF 35937 - Reviewed 2026-11-02
- Documents to include
- A W-9 form must be on file with the FSSA Accounts Payable Office or the claim will not be paid.
Claim to Defray Funeral and Cemetery Expenses SF 35937 - Reviewed 2026-11-02
- Languages
- English
Claim to Defray Funeral and Cemetery Expenses SF 35937 - Reviewed 2026-11-02
- Official page
- https://www.in.gov/fssa/dfr/forms-documents-and-tools/forms
DFR: Forms - Reviewed 2026-11-02
- Direct form link
- https://forms.in.gov/Download.aspx?id=4947
DFR: Forms - Reviewed 2026-11-02
- Revision date
- R6 / 4-22
Claim to Defray Funeral and Cemetery Expenses SF 35937 - Reviewed 2026-11-02
- Signature
- Pursuant to the provisions of IC 5-11-10-1(e), I certify that the foregoing account is true and correct, that the amount requested ($ ) is legally due, after allowing all just credits, and that no part of the same has been paid. Signature of Funeral Home / Cemetery Representative Date Signed (mm / dd / yyyy)
Claim to Defray Funeral and Cemetery Expenses SF 35937 - Reviewed 2026-11-02
- Accessibility
- Not listed yet. Call to confirm.
- What the form says
Claimant must complete, sign and date form. Submit to Family and Social Services Administration (FSSA), Division of Family Resources (DFR), within ninety (90) days of date of death. Instructions on how to complete and submit form are on page 2.
Claim to Defray Funeral and Cemetery Expenses SF 35937 - Reviewed 2026-11-02
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