Line of Duty Death/Non-Line of Duty Death Assistance Request Form

Financial assistance is provided to the families of public safety officers and firefighters upon death; aid is also extended to officers and firefighters who are called to active duty military. Assistance is extended to volunteer and/or reserve officers/firefighters only when the incident occurs while he/she is on duty. To request assistance for a public safety officer or firefighter, the appropriate form must be completed by a supervisor or by human resource personnel. Potential beneficiaries are not authorized to submit requests. If you have questions, please feel free to call our office at (602) 975-2527.

Please use the links to the right to fill out the appropriate request form. If you are not contacted by a 100 Club of Arizona representative within 24 hours after submitting your request, please call our office at (602) 975-2527 to verify that your paperwork has been received.

WE OFFER ASSISTANCE IN CASE OF:

LINE OF DUTY DEATH (LODD)
$20,000 one-time assistance

ON DUTY DEATH (ODD)
$15,000 one-time assistance

NON-LINE OF DUTY DEATH (NLODD)
$10,000 one-time assistance