)'s and Surviving Divorced Spouse's Benefits
SURVIVING DIVORCED SPOUSE'S BENEFITS. Page 1 of 2 OMB No. 0960-0759 (over) 1. Print Name of Wage Earner or Self-Employed Person (Hereafter called "Worker") ... • If another beneficiary is entitled to a monthly survivor benefit on this Social Security number, your benefit may be reduced ................
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