Application for Estate Refund
*Deceased Member-Owner Name:
*Social Security No. (last 4 digits):
Provide the county where decedent had primary REC account.
County of primary REC account:
*Date of Death:

I/we understand that I/we have to provide the cooperative with a copy of the death certificate. Also, a Letter of Administration/Testamentary from the Clerk of Court's office will be provided to the cooperative if the funds are to be sent directly to the applicant(s) of this application, otherwise the funds will be sent to the county's Clerk of Court of the location of the account(s). Lastly, I/we understand that the decedent cannot have an active account with the cooperative if the deceased estate capital credit funds are to be released, regardless of any payment method.

Please remit the following along with the application:

1. Death Certificate (REQUIRED)
2. Letter of Administration (If Applicable)

Instructions for submitting documents are included at the bottom of this application.

Applicant Profile:
*Phone Number:
*E-Mail Address:

Capacity in which undersigned make this application is:
*Undersigned Capacity:
What is the relationship of the undersigned to the decedent?
Relationship to decedent:
Payment Method #1 - Periodic Installment Method

I/We agree to accept the full 100% face Value of each yearly amount assigned to the decedent while he/she was a member with the understanding that such payment will be made in periodic installments on the same schedule as for living members when Capital Credits thru General Retirement are declared payable by the Cooperative's Board of Directors. I/We understand that under the present Capital Credits Retirement Schedule it will take 15-20 years for the full cumulative amount to be paid. I also agree any final balances due the Cooperative shall be paid out of the payments.
Payment Method #2 - Present Day Value Method

I/we agree to immediately accept the present worth of the total Capital Credits assigned; which is the discounted present day value of all Capital Credits assigned. In accepting this one time "lump sum" final payment, the undersigned representative(s) of the decedent's estate hereby irrevocably donate to the Cooperative the portion of such credits not paid to include any Capital Credits assigned to the decedent as a result of capital or similar credits being realized by the cooperative from any cooperative affiliated organization. I also agree that any final balances due the Cooperative shall be paid out of this refund.

The undersigned hereby represents all information to be complete and accurate to the best of his/her knowledge, and agrees to hold the Cooperative harmless from any liability that may arise out of its retirement of Capital Credits based on such information.

Click here to draw your signature.

With your mouse, draw your signature. Then click Finish.


If there are any questions about the estate refund application, please call Roanoke Electric Cooperative at (252) 209-2236. Or, send us an email at

Instructions for submitting additional documents:

There are five methods available for submitting additional documentation.

Method 1: Electronic File Upload

You can upload an image or PDF using the file upload tool, below.

The file can be up to 10 MB in size and must be one of the following file types: PDF JPG JPEG PNG GIF ZIP.

If you have multiple files, you can combine them into one zip file (using your zip software) and attach the zip file to this application with the file upload tool.

Attach Document:
Method 2: Fax

Fax copies of pictures and paper documents to the fax number below.

Method 3: Electronic Mail

After submitting this online application, you will receive a confirmation email. By replying to this email you can submit electronic copies of scanned images and PDFs by attaching them. Use the personalized subject provided to ensure your documents get delivered to the right place.

Method 4: Online Upload Tool

After you submit the online application, you can provide additional materials by using our online document upload tool. You will receive more information about the upload tool after the application is submitted.

Method 5: Postal Mail

Mail copies of pictures and paper documents to the address below.

Roanoke Electric Cooperative
P.O. Box 1326
Ahoskie, NC 27910
Phone: 252-209-2236
Fax: 252-209-5055

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