“IC‘DE%*‘50 469 PPDVIDE DA , EISI OF OCCURRENCE ON SEPARATE SHEET IN AC- CCGDANCE RTTM SPECIAL INSTRUCTIONS ABovE. NO J EAVRSOusiburat SECTION XXV PERSON TO BE NOT IF ED IN CASE OF EMERGENCY 1 1. NAME F ast-3-ddle-Leath 2. RELATIONSHIP Bella Amron wife 260. a-shal. court”
“Above NAuF of S"CUst ADDRESS (No., S City, Zone, State) TELEPHONE NUMBER - NAMES OF CHILDREN ADDRESS SEX AGE James Same M 12 Sally NAME OF FATHER (Or malo guardian) F 18 MO. Decensed ADDRESS TELEPHONE NUMBER ndiana polis, Ine L2519 NAME Of wo TwER (9r SARA K. HARVEY”
“PERSON TO BE NOTIFIED IN CASE OF EMERGENCY 2. RELATIONSHIP Eileen slicabeth Maksyziee wife 3. MOVE ACONES L.No . Street, City, Zone, State, Country: 4. HOLE PHONE NO. 525 S. Yalle- Dr. Alax. TE 6-8213 $. BUSINESS Dess (No.. Street, City, Zune, Siato, Country) • HOICARE NAME”
“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”
“Wifeonly________________________________ 4. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY NAME (Mr., Meo.. Mioo; RE EATIONSHIP " Lynch, Herbert A. (Lest-Pirst-MiJdio) Hrs Jone Mtso K-feuch Wafsbrother HOME TELEPHONE NUMBER Box 46-9, Victoria, TEXAS HOME ADDRE ss (De. Lae ”
“Church,Vi. NAMES OF CHILDREN ADD€39 (Number) (Street) (City) (State) sex AGE Maureen P. O’Connell F 23 Virginia D. O'Connell F 19 James P. O’Connell SAME M 17 John D. O'Connell M 11 NAME OF FATHER (or male guardian) ADDRESS (Number) (Street) (City) (State) TELEPHONE Dece”
“14-00000 psr: >! S-VIR atsth fit vl « DISPATCH SECRET UFGA -27424 4. Notification of the following changes in Payees is also forwarded for the amendment of Headquar tors records: Case #29 ALEMAN Aleman, Eufracio (201-290479) Payment transferred from the trustee to the ”
“Michael Carolyn Anne M Card StevenMcCord NAMES OF CHILDREN I. 4 4- Nancy Ellen McGork E - 2-2 Conor James W McCord Sr Fan Dedogne SalliePsir reng Xierat • AME OF FATHER (or male guardian) ADDRESS (Number) - (Street) (City) (State) TELEPHONE 1- Margerie Lee McCord gu”
“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 ”
“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 ”
“14-00000 CONFIDENTIAL raN Filled In) *- _ * VOLUNI AR Y ENTRIES _- __ Erobe fence in the handling of employ.- encr.vi dies ac. alicon inc. the O’seare e! certern prracaa! deta often de’ay: ar d comp’: caret the settlement of estate and financial matters. The information req”
“14400000 PITS0L s Y* mottez d*te*gdkawyo zgigt./es - ::: on employed in full: Ricardo Anibal HCUALFS Navarrette ra %o be notified in case of emergency: 1a:e Magda Morales .. Relatlonshriwit:_ 0rcso . . 535 Soutj "cs 7th St., -t. 2 Mhiadicorida . celeghes 371 5141 . o”
“FatHIN (or nole guardian) a06agss (Number) (Street) (City) (Nhdto) ELlPHONE NAME or woTstN {or female duardien) *000535 (Number) (Sieoot) (Cl »?) (Sente) TtlEPwONE :. PER304 TO % NOTIFIED IS CASE OF EMERGENCY NAME PAtionsai? ADOREGS (Number) (Street) (Caty) (State) TELEPHO”
“-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”
“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”
“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 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, ”
“the power of attorney?) wife 6. Re: Item # 4- Contact For, Emuercency Should ADDITIONAL DATA AND/OR CONTINUATION OF PRECEDING ITEMS Follow The Below ander P. Wife (Trem3) B. Bother (Item 4) C. IN-LAWS MR. Norman H. Wy ATT RTE 2 Box 342 B MANASSAS, VA. 22110 Tel: (7”
“CONFIDENTIAL (When Filled In) 9. VOLUNTARY ENTRIES Experience in the handling of employee emergencies has shown that the absence of certain personal data often delays and compli cates the settlement of estate and financial matters. The information requested in this section m”
“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”
“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”
“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”
“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 ”
“14-00000 CONFIDENTIAL H’^ Fetlo. /ri VOLUNTARY ENTRIES Experience in the handling of employee overgencies has shown tent the absence of certain personal data often de - lays and complicates the settlement of estate and financial matters. The information requested in this s”
“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”
“1 4-00000 Cdco/gzt CONFIDENTIAL (When Filled In) s. VOLUNTARY ENTRIES Experience in the handling of employee emergencies has shown that the absence of certain personal data often delays and compli cates the settlement of estate and financial matters. The information reque”
“14-00000 CONFIDENTIAL (%* Filled :- 5. VOLUNTARY ENTRIES Experience in the handling of employee emergencies has shown that the absence of certain per son al data often de - lays and complicates the settlement of estate an d financial matters. The information requested in t”
“A POWER CP ATTORNEY’ C ven (7 NO. revov”, who pobseea the pvwer of attorney”) ’ Myanfather chned not emergeny because y be rati o herned in con ADDIT IONAL DATA AND/OR CONTINUATION OF PRECEDING ITEMS health and 9 Age SIGNED AT Amiel 0 Daniel TOlore X sionafus CO”
“14-00000 CONFIDENTIAL (When Filted fey & wiLOfe Jointly 52 (CONTINUED) ■ ‘.’ 1 IN most NAME(S)‘ARE tit accounts LISTED* SelFt Have YOU COMPLETED A LAST WILL AND TESTAMENT »1 - 00, If "vt9",. wiet is occomENT Cocarkor • r HAVE vou EXECUTED A POWER OF ATTORNEY? 0•0.115”
“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”
“14-00000 CONFIDENTIAL (When Filled In) ___________________________________________________ VOLUNTARY ENTRIES______________________________ ___________________ Experience in the handling of employee emergencies has shown that the absence of certain personal data often delays”
“HaaschPhillips_____ NAMES OF CHILDREN __ 969 (Number) LaneFalls Church ___ Rose(Street) Va. JE-3-9579 (State) SE% AGE __ ADDRESS (City) Maria Louise Phillips n n n I Female David Atlee Phillips, Jr.- ‘n- I n n Male 3 Atlee Young Phillips sr n n n Female 2 NAME OF FATH”
“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”
“ty) (State) SEX M M ACRES 2th * Clifford E. Randall 2127 Wyoming St Omaha, Nebo, tenont 1 Bernice Randall 08 eaunedy n) %. PERSON TO 81 NOTIFIED IR CASE OF DERGECY ADDAL55 (Number) (Strut) (City) 11 (State) TELEPHONE st Clifford E. Randall naug Father RELATIONS”
“at PAID to TYPE OR PRIT FIRST NAME MIDDLE INITIAL, AND LAST NAVE hre or PRINT ADDRESS rnchuding ZIP Code) or EACH MNERCAN RELATIONSHIP EACH ME NLFICIARY of LACH BENLE ICIARY (See Example: 5 villa Madrid, 95 Neuilly, France Pamela A. Richardson Dau One half Jr A 11 10 0005”
“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”
“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”
“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 CONFIDENTIAL (whan Fitetini 9. VOLUNTARY ENTRIES Experience in the handling of employed emergencies has shown that the ob sence el certain personal data eftea delays and compli- cotes the settlement of estate and financial matters. The information requested in this”
“14-00000 dgt CONFIDENTIAL (When Filled in) 5. VOLUNTARY ENTRIES Experience in the handling of employee emergencies has shown that the absence of certain personal data often delays and compli- cates the settlement of estate and financial matters. The information requested ”
“INSURANCE due and payable at my death, / 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 as it is automatically canceled (see regulation "f" o”
“14-Q0000 CONFIDENTIAL ruhen Filled In) s. VOLUNTARY ENTRIES I" wrience in the handling of employee emergencies has shown that the absence of certain personal data often delays and compli- & as the settlement of estate and financial matters. The information requested in this”
“14-00000 t CONFIDENTIAL (when Fitted fe) 5. 1 VOLUNTARY ENTRIES Experience In the handling of employee omergencies has shown that the absence of cortoin por son al data often de - lays and complicates the settimont of esteto and financial matter a. The information requeste”
“00 #87 ’FEFSOCAL.0 Na ofcemployeq in /tl.: —An tonio • So to -— Person to be notified i: case of erengency:: .Dolores Soto. fe ----- -—— A-.-379 E-65.Street,Eialeah --- Te leph one 681-8685_ i Designation o BETelse Yncy, Nane_ - -Same as above Fed a Crtemyas -.-, Ad”
“ADOPESSEET X YE S •9 Ing PERSONS NAVCO 1* TEM ? amovE ahe ALSO BE NOTIFIED IN Ca5F of EMERGENCY. IF SUCH NOTIFICATION IS NOT DESIRABLE BECAUSE OF HEALTH 09 OTHER PEAS065, PLLSE so STATE IN ITEM 6 Ore THE REVERSE 5160 OF THIS 10ww. VOLUNTARY ENTRIES InDiCAft ANY BANKING I”
“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”
“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”
“14-00000- CONFIDENTIAL (When-Fiited te) P.___ ____ _3 VOLUNJARY-ENTPIES-.13_290 IE sper lence in the handing of employee emergencies has shown that the absence of certain per sonol data often delays and compli- cates the settlement of estate and financial matters. The infor”
“(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 -”