“__ ___________ - Pit in nos I. t elect not 17 enroll xrry sins 3 The reuson for my election is (Plouce un "X ‘ in proper bos) PART I/ vou under the Megi Benufio Act. tal / am rovcied by o plon under the ro-alth Benefits Act through the enroll, won NOT 10 men of my husband, wi”
“below from inside cover of Lro.bore of the plon you select) PART: NAME 3 RUN OPTION (HIGH OR LOW) INKMENT COO NUMBER WISH10‘1N- POLL IM A . HEALTH BENEFITS PAL. - * Association Benefit : Lt soa :e s list all eligible for member v.H low 1•! 1 tescephon: List your wile o”
“1 4-00000 6 — CONFIDENTIAL Ty R June SE (When Fillet (n) 2 I. NAME Bagley Tennent H. THE FOLLOWING ACLECy SCONSO9TO INSURANCE PROGRAMS HAVE DF:N EPLAINED 10 ME 0A8 acunci RMPlovees NTECtevt association (WAEPA) (Middle) J. THIS n- PDNGao DIBEADs CO osour BOPITALIZ”
“ILALTH BENEFITS /LAW. Association Benefit Plan 11High 4 2 : 2 2 In spruce Le lit off r exception: List you: hurbend first, then your unmarried hdren d.je I?, including legally telopted chideen, and decelldren sed silegtenate ch den who Wise with ,00 ddv a regular pareot-cniid”
“U. Blanford Farm No. 34 Ration April 191% (7iv8] herviro Commission wpst DESIGNATION OF BENEFICIAR * IMPORTANT r. P. 94. Chapter al Read Instructions 84 jus FEDERAL EMPLOYEES’ GROUP LIFE on back of duplicate INSURANCE ACT OF 1954 before filling in this form INFORMATION C”
“mtnederl F’orin NO, 00 Seylender 19′1 V. B. CHil Sorviea fcr-tnJeelon DESIGNATION OF BENEFICIARY IMPORTANT V. r, 84. Chapter 2.9 ■.. Read Instructions FEDERAL EMPLOYEES GROUP LIFE on back of duplicate' INSURANCE ACT OF 1954 before filling in this form: . INFORMATION CONCE”
“Cted-CAjmderficilniinelonerun. 2CL1-1 AfW . MIALTN SEMESITS Association Benefit Plan High 422 —MAM.n «1 2. In spore.below listiell elnible fiml], members without exception yjon your-wdo » o or, ewarones eymn Grot; fimi yoorvnmarrist chyen-undee iideen -4. oge.19, including”
“menaton, cor nnnody ol the yyhar yvo roloct J Fill in DIS PART If ToU NAME or MAN OptiOre (20 o* 12 wBSCOXNE wiSl to (i- RUN IN A HEALTH BENEFITS ASSOCIATION BENEFIT PLAN____ HIGH 4:2 LI PLAN. 2 In space below List eslt •: gible fescvily members without o,/lieon t.ct your”
“information wquesed belev hom inside fover of brochure of the ple you select PART IF rou NAME 0 MAN Grich (MUIGH or low) droitwNt CooNuG WISe-To Bl- POLL IN A ASSOCIATION BENEFIT PLAN HION HEALTH FDIDHIS MIAN, *. in spoco bplow to all eligible family m alal 2 1 embers wit”
“IGADE DEPENDENTS. JMWAVE PLANS TO HAVE • AMT IK I-1 PROVIDE MRS. MOL INA WITH THE NAME OF THE OR IG INAL • TRUSTEE AND THE AMOUNT PA ID TO HIM W IT H REGRETS T HAT HE CANNOT . ASSIST HER IN THIS MATTER. WE ALSO PALN TO HAVE AMT IK-I EXPLA IN THE METHOD OF COMPUT ING THE $13,1”
“name, midlie Jocitinl and Innt neciai-sa Relationship Share to ba paid to of rack tononiclary ‘, . • a Type or print address of each Lenedelnry each bonefolary.‘ John M. Parrish, if living.— 810 West 180th Stroot, New York, H. Y. Father All Otherwise to: Susan A.' Tarrish 810”
“living at the time of my death, are - 3135 * "14 d_. 2205 . - .i 1 hereby-sper-soziz reserve the right to cancel or change this Designation of. Beneficuara of any tiine without knowledge’ - ■ (Date of sin month, day rear))” WITNESSES TO SIGNATURE (Silises a ineligible is A”
“am continuously employed in the above department or agency. Inronano CEN CKENING THK BrNEICIRY on BKNSFclB: Type er print Bret name, mikile initial and inet name Type or print address of each beneficlary fihare to be wild to of each benedelary Relationship each he nefiovary ”
“1 4-00000 SECRET PAGE 2 JMWA VE 5954 SE e RET. AND POOR HEALTH (MR. CERVANTES"1S ILL WITH A CHRONIC HEART CONDITION AND IS UNABL MARN02527M ‘IPs. CERVANTES IS UNABLE TO LEAVE HIM ALONE IN ORDER TO SEE-K-EMPLOYMENT, SINCE THE DAUGHTER-IN-LAW NO LONGER LIVES WITH THEM.) TH”
“CANCELS ».$ 104 +ot mp JrCtiviNt PART 8 * WayaxzEr •^^^^.^ se en I authorise deduce belgy hom bod poge of be - • veidrv, compensation, of unnoaty to cover my share of the ros > o’ the plan you select ) Tilt IN THS | CUE Or RAN OPiON (MGH or IOw) tomoument core Numsin PARE.”
“14-00000 I CONFIDENTIAL (When Fitted tn) 1. ICONTINUtO) IN #HON NAME(S) ans fur accounts LISTED My name only ________________________ Have you COMPLsIED a Last BILL AND TestAMEErO CXX ”‘" •o. ir "vest, mesne 13 DOCuMENT LOCATSOI With me in my personal papers • wAvivou”
“1 4-00000 IMPORTANT.—The filling of this form will completely cancel any Designation of Beneficiary under the Federal Employees’ Group Life Insurance Act you may have previously filed. Be sure to name in this form all persons you wish to designate as beneficiaries of any grou”
“14-00000 CONF IDENTIAL : (whin Pilled.3e).. 5. (CONTINUED) G is most Nalttoo she THE AccOUNts Listrprm WAVE DAVID A. PHILLIPS, SPECAmIAL ACCOUNT A LAST BILL anD TESTAMERV? no. se “res”, aw’at is oocuwinT LOCATED? wAvE LAW BUILDION BANKOFFICES T TOOHTIP NG,ENDON FO”
“Act. 69: ; vse covered by a plain under the Hegfth E-nefes Act through the enroll »7 N07/70 eyaera of my husband, wile, fir parent, frrnt 09 If rter win Vs caNT91 100 2. ) elect to roncel my prasant enroll- L : gm reted by a health sutonte plon which % not under the Heoln L”
“I3 ORTAN3.--The filing of they form will completely cancel any Designation of stneiciary under the Federal Employees’ Group Life Insurance Act you may have previously tiled. Be sure to name in this form-all persons you wish to designate as henenclaries of any group life and acc”
“14-00000 IMPORTANT.—The filing of this form will completely cancel any Designation of Beneficiary under the Federal Employees’ Group Life Insurance Art you may have previously filed, Ite sure to name in this form all persons you wish to designate All beneficiaries of any grou”
“1 4-00000 IMPORTA N'T.—The filing of this form will completely cancel any Designation of Beneficiary under the Federal Employees' Group Life Insurance Act you may have previously filed. Be sure to name in this form all persons you wish .to designate as beneficiarlea of any gr”
“14-00000 j. IMPORTANT.—The filing of this form will completely cancel any Designation of Beneficiary under the Federal Employees Group Life Insurance Program you may have previously filed. Die sure to name in this form all persons you wish to designate as beneficiaries of an”
“(KOLMNT UNLESS THE fauty ME MN • CAPK F1S PIS ,04 Mtt> O-XIMIN! PART B 1,8 elect N en-l • o SeoNA beneAn p’on os shown below, 1 cut 190 -* —solery, compensonon, or onneily to cover •» were of the test ol the enraliment (Copy the infer motion requested below from bort pege el -”
“CONFIDENTIAL (When Filled In) 9. VOLUNTARY ENTRIES -___ Experience in the handling of employee enargencies has shown that the absence • certain porsonal date often delays and compli- cotes the settlement of estate and financial matters. The information requested ^ this sectio”
“a 4 £ & t£ u & ^ ^ J IMPORTANT—The fling of thin form will completely cancel any designation you may have presionly failed. Be sure to name in thin form all persons you wish to designate as beneficiaries of any waguid compensation payable at your death. sal EXAMPLES OF DESI”
“other than’ the above, or until much time as I beconie Insured an a retired employee. In which event this Designation of Beneficiary shall terminate. " INFORMATION CONCERNING THE BENEFICIARY OR BENEFICIARIES: Type or print Nest nhine, saiditle initial, and last name " " Tsso”
“csicadle initial, last name Type or print addreen of each beneficlary Relationship Bhuse to t-e salt to ed each beneficlery each Lenebesary John M. Parrish. If living ! 810 West 180th Street, New York, N. Y. Father A11___ . Otherwise to: Susan A. Parrish 810 West 180th Street”
“-wave vou ExECutso * POWER of ArromuKy?: Yes m No. (If “Yea", who possess the power of.attornoy?). 4LLJ- 26019734 ADDITIONAL DATA AND/OR CONTINUATION OF PRECEDING ITEMS nNoterMg brother-in-law, Wohn Waishihas been named executor in both ■ | the will of my wife and my will. ”
“CONFIDENTIAL (Sten Filt.n fhl 5. VOLUNTARY ENTRIES "eperienco in the handling of employee emergencies shown that the absence of certain son el dets o ft en de • laya and complicates the settlement of estate RN d financial matters. The information requested ; this section we”
“his doelcration Is basca on oll Information of vhicli ho has any tinsizlodgo. EDWARD L. LAMBERT P 0 SA D D •TAX.CONSULIANT Your signature—? Cling jointly, B07W must sign Dato E n 598919 VienrrOfAthnLVn.fongrr : clou O ENCINO, CALLE.91316 Spouso’s olgnatero Dato T227213) 88”
“or until such time ds I become insure d as a retired employee, in which erent this Designation of Beneficiary shall terminate. INFORMATION CONCERNING THE BENEFICIARY OR BENEFICIARIES: • or print first name, middle initial, and last name Type or print address of cash beneficiar”
“14-00000 Slandant Form No. 1152 4il 40 J00 11-12- DESIGNATION OF BENEFICIARY IMPORTANT Read, instructions USrato COMPENSATION OF on back of duplicate DECEASED CIVILIAN EMPLOYEE before filling in this form INFORM tries CONCERNING ras EHrtOYEE:' NAME- (Lait) (First) (Mid”
“power of uttomey?) Believe the lawyer has this also «. ADDITIONAL DATA AND/OR CONTINUATION OF PRECEDING ITEMS P R E M TXASTeRser SIGNED AT J LAY Bara arc 1970 CONFIDENTIAL 7Marlalle B Barta Kill”
“1 4-00000 Mlandant Fortu %. 1132 DESIGNATION OF BENEFICIARY e. • IMPORTANT 119 $ G9 UNPAID COMPENSATION OF Read Instructions on back of duplicate DECEASED CIVILIAN EMPLOYEE before billing In this form INroRanios CONCERNING Tns EMrOYEa: NAME- (Lactj First) (Millie) Date”
“consent of the beneficiary. Mar 27,-1963 (Iata of szecutlon--month, d-y, year Robert Khaw {Signature of Inaured) Mari 2.100 1114 Ellen Ave.Noe Falls Chad, Ken W ITNESSES TO SIGNATUR € (A ivitness ia ine Gimble to receive payment as n benefcinrg): mcbiksbnlseniends (ignat”
“14-00000 CONFIDENTIAL ,te r.de: • a 9. VOLUNTARY ENT RIES_ _ _._ • Experience in the handling of employee emergencies has shown that the absence of certain personal data olien delays and compli-1 cates the settlement of estate and financial mate s. The information requested”
“14-00000 CONFIDENTIAL when Filtee In) VOLUNTARY ENTRIES ' __ Experience in the handling of employee energen : has shown that the absence of certain sex tongl data often delays and compli- totes the settlement nl estate and financial matters. The information requested in thi”
“CONFIDENTIAL (Ten Filled tel ,86. VOLUNTARY ENTRIES Experience in the handling of employee emergencies has/shoun that the absence of, cortata per.con al deta often de - lays and complicates the settlement of estete.md financial matters. Tre information requested in this sect”
“T - -3- principal himself or his heirs has the legal right to. revoke a trusteeship even in the mishandling of funds. Based on a review of pertinent documents and a discussion wit h Mrs. Evie Vidal Fa who is probably more know ledgeable of the facts and nuances of this ”
“GROUP LIFE INSURANCE and GROUP ACCIDENTAL DEA TH: INSURANCE due and payable at my death. I understand that this Designation of Beneficiary will remain in full force and effect, with respect to any amount payable, unless or until canceled by me in writing, or until such time gai”
“14-00000 you may wish to discuse your personal situation with your attorney or a rep- resentative of JKLANC E’e office of General ( ounsel. in the meantime. however, JILANC E’e position with respect to your situation is that it assumes the validity of your current marriage, ”
“14-00000 .CONFIDENTIAL (When Prited In) VOLUNTAR % ENTRIES____ Experience in the handling of employee emergencies has shown that the absence of certain personal data often delays and cempli- cates the settlement ofjestote and financial matters. The information requested in ”
“Share !•! be paid to < : ‘t edict Nanenictary | : each besetciary John. W. Parrish, if living 810 West 180th Street, Now York, N. 7} Father - Alls. Othersise to: Susan A. Parrish 810 West 130th Street, Now York, n. vol Sister. 1 All : How TOCANCEL 4 Iksiasafos or HRSEFICAR”
“EADONSHi? Date or vvtn / Mo. du, ye.» examination which will be arranged try the Director uf Prrvomene! at noi eevot to you. • If the tenvn named as having an incurable interest should die Sce VedMADDllD eMPLO1485 untita TItC-BePAtiCte D1OA90010 SURVIVOR hefint wins no change”
“14-00000 CONFIDENTIAL (When Filled In) "._ VOLUNTARY ENTRIES Experience in the handling of espivyee emergencies has shown that the absence of certain personal data often delays and comply cotes the settlement of estate and hnencipi matters. The information requested in this”
“paid to of each beneficlary ' Type or print nditrese of each beneficlary Relationship ; each Lenefciary Toll N. Farris", ir living 1 310 sont 180th Street, No. York, N. Y. Father All Otherwise to: Susan A. Parrish 810 West 180th Street, New York, N. Y. Sister All How To CA”
“14-00000 1 L CONFIDENTIAL jaw) Fitted In) s__________ VOLUNTARY ENTRIES Experience in the handling of employee emergencies has shewn that the absence of certain per-unit dutg often 19/7/8 and compli- very useful to you rates the settlement of estate and financial mofte”
“in which event this Designation of Beneficiary sal terminate." INFORMATION CONCERNING THE BENEFICIARY OR BENEFICIARIES: Tape or print first name. mildwinitinl and last nateel Type or print address of cach benedlelary oShare to be paid to lef each beteLciaryse . ten” A each be”
“I l: vcaomincd tfio roauta, including cccomponying schoduloo and ctotomonto, and to tho boot of may tnswlcdgo and colici al . it 46 tres, c rreci, EhG 09K3plot:), Declaration of proparer (othor thon toxpoyer) in boscs co all information of which he has ony Dnovlcdgo. k SCUj You”