“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”
“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”
“afient is over the age of eighteen years and in act a party to the business - *.*..: within above entitled action; that affiant’s residence address in:- that on the. —day 6- t19. sfiant served the within... on the__ _ —in said action, by placing s true thereof in an envelo”
“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”
“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”
“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”
“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”
“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”
“of execation—month, day, year) (Signature of employee) ne Ave Rochelle Nd WITNESSES TO SIGNATURE: (Number and street) (City, zone number and State) (Signature of witness) (Number and street) (City, zone number, and State) PRINT OR TYPE NAME AND ADDRESS OF EMPLOYEE THIS S”
“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”
“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”
“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”
“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 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”
“declaration and to the best of my knowledge it is correct. Signature(s).......................................... ............................................................. .. Date. .., 19. ..... NW 88326 Docld:32245535sPage 228 husband and wife must sign”
“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”
“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”
“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 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”
“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”
“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”
“designated beneficiaries is living at the time of my death. / / hereby specifically reserve the right to cancel or change this Designation of Beneficiary at any time without knowledge Gladey1218 OroLnoco.St. AlVienna, or consent of the beneficiary. (Date of execution— mont”
“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 ”
“good faith. Date. Signature ol apphoant ______ .... (Sign your name in NK tone given non. n male and surname), it lemala pro is Miss or • Ono 0-10 47700 % / . Mas and d marne I use four own atve ** Mary L Doe.") . abannviliw-a-wADG-tetA.”
“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”
“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”
“which was to the depositor after cancellation, the identity co is not Nr s. Prio has a set deposit et a breach of this husband be--”
“print fret name, middle-initial, and last name — of each bonefelary. TX.7 5 —a Tyrejce print address of each beneliclary - wosdeluding ZIP.4ode9 1 Relationship. Nek Bl-dley 810 West 190th: Street John M. Parrish, if living New York, N.Y. 10033 Father All 3 810 West 180th St”
“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 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”
“__ ___________ - 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”
“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”
“e.AtiQeei? ario Data or giefp or fug PiDLC sou wiser • The survivor’s annuity will begin upon your death and end when to atrtiva tht suaviver ArNuite she tor hie) dies miasef or MPa. 4 0 apsf. med.fle, fast) • The survivor’s annuity will be 55%, of the redfucot annuity you •”
“VITCAANT YTS- NO 17. EXPIRATION DATE OF RETEN TION RIGHTS • 8. Tit MOTHER 07 A DECEASED OR DISABLED VETERAN? YES Ko C TIE UNREMARRIED WIDOW OF A vttan YES 51 NO & TO BE EXECUTED BEFORE A NOT ART PUBLIC OR OTHER PERSONS AUTHORIZED TO ADMINISTER OATHS. I swear (or affirm) tha”
“Richarie Better (Date of execution—month, day, year) (Signature of insured) WITNESSES TO SIGNATURE (ct witness is ineligible to receive p’vnecnt is a beneficiary):- 13219 AlembieU 1 Number and street) Rochelle Nd and ZIP Codes (Signature of witness) its. State, and ZIP Co”
“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 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”
“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”
“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”
“belon receive 4 any amount of LIFE IVst RANCE and ACCIDENTAL DEA TH INSURANCE due and payable-atimy death: Funderstand that this Designate of Smeficiary will-remain in full force ami effect, with respect to any amount payable, unteas or Anti canceled by me u writing, or until ”
“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”
“. ' 19. Do you understand that all payments made to you on behalf of a child must be spent or saved’ for his use and benefit, and do you agree to so apply the benefits?...................... Yes No 20. Do you agree to notify the Social Security Administration promptly when you”
“CONF IDENTIAL (UNen Fiitee te) 5. VOLUNTARY ENTRIES IExperience in the handling ef employs epergencib, has sho’m test the absence of-certeln. por sonal data often de - I lays and complicates the cettlavent of estate and financial matters. The in formation requested in this s”
“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 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”
“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”
“NO. (II "Yoo” give nome( C88 "Yoe" s) and addrose) name’’s) addrose) - Jr accigung Clicker The Nattoned Bank n Washington who presses the power of attorney?) 0 ADDITIONAL DATA AND/OR CONTINUATION OF PRECEDING ITEMS $0000 AT TOAYe SIGNATURE June.28 1967 Olianenth L Busti”
“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 ”
“14-00000 Standard Form N^ 1152 Cxw Farm prescribed by • • Comptroller General, U.S. DESIGNATION OF BENEFICIARY IMPORTANT October 23, 1930 Read instructions (Gen. Reg. No. 1u4, Supp.No. 1) UNPAID COMPENSATION OF 1 on back of duplicate DECEASED CIVILIAN EMPLOYEE I before f”
“(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 -”