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Information Checklist
In the event of a death/disability of an eligible public safety officer, the Public Safety Memorial Fund Board requires certain forms and information in order to administer the rules and laws of this legislative act.
In the event of a death or disability, the employing agency must provide the following to the Memorial Fund Board:
  • A completed Form M-3 notifying the Memorial Fund Board/DPSST of the death or permanent, total disability of an eligible public safety officer.
  • A summary describing how the incident occurred, including the date, time and location and the cause of death or disability.  This information must be provided by the employing agency to assist the Memorial Fund Board in determining eligibility for benefits.  The Memorial Fund Board may request additional information.

NOTE - Employing agencies must provide form M-3 to the Memorial Fund Board within three (3) days from the date of death or notice of permanent, total disability.  Because the Memorial Fund Board is working under a 14-day timeline to pay initial benefits, a summary of the incident relating to the death/disability must be sent to the Memorial Fund Board/DPSST as soon as possible.
In the event of a death/disability, send the forms to:
DPSST - Memorial Fund Board
4190 Aumsville Hwy SE
Salem, OR  97317