Proof Of Burial And Funeral Expenses By Undertaker {C-65}

C-65 - PROOF OF EXPENSES FOR BURIALS, FUNERALS AND MEMORIAL SERVICES BY UNDERTAKER. This form is used to provide proof of expenses for burials, funerals, and memorial services by an undertaker in the context of workers' compensation. It requires the WCB case number, carrier case number, and the social security number of the deceased individual. The form includes a sworn statement by the undertaker stating their licensing information and the details of the invoice for the services rendered. The form also includes a warning regarding the consequences of providing false information. It requires the signature of the undertaker and must be notarized. www.FormsWorkflow.com