To complete the claim on the account of the deceased member, you will need to provide the proper documentation from the Clerk of Superior Court, Estates Division. You may mail the estate papers to: Randolph EMC Attention: Capital Credit Dept. P. O. Box 40 Asheboro, NC 27204

	*Indicates a required field.
	Capital Credit Identification Number:
	*Name of Deceased:
	*Account Address:
	*City:
	*State:
	*Zip Code:
	*Date of Death:	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2010 2009 2008 2007 2006
	Name of Executor or Administrator:
	Address of Executor:
	City:
	State:
	Zip:
	Executor Phone Number:
	Name of Living Spouse:
	Address of Spouse:
	City:
	State:
	Zip:
	Date of Claim:	7/31/2010 11:43:36 AM
	Claimant's Name:
	Relationship to Deceased:
	Claimant's Phone Number