kleanYA Family Application

Covid-19 Victim Information

Full Name

Date of Birth

Date of Death

Applicant Information

Last Name

First Name

Relationship to Beneficiary

Relationship to Deceased

Email Address

Mailing Address

State

City

Zip Code

Street

Beneficiary Information

Same as above

Last Name

First Name

Relationship to Deceased

Email Address

Mailing Address

State

City

Zip Code

Street

Beneficiary PayPal Account

A valid PayPal account belonging to the beneficiary is required. Click here to learn more about PayPal.
A valid email account for the beneficiary is required.
Just share your very own PayPal.Me link (paypal.me/YourName) with us

Covid-19 Victim Official Obituary

Upload File Url Address

Covid Story

Upload File Write

Covid Story Photos (optional)

Program

kleanYA Family Application

kleanYA Families

Obituary

Keith and Serpil

kleanYA Family Application

Covid-19 Victim Information

Applicant Information

Mailing Address

Beneficiary Information

Mailing Address