“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”
“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”
“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 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”
“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”
“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”
“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”
“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”
“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”
“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”
“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”
“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”
“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”
“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”
“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”
“under "Remarks.”) Yes v. No 'this check was illegally cashed, you will be entitled to payment of the amount of the check; however, another check in place of it will not be issued until the case has been fully investigated by the United States Secret Service. As it may be neces”
“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”
“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”
“illegally cashed, you will be entitled to payment of the amount of the check; however, another check in place of it will not be issued until the case has been fully investigated by the United State: Secret Service. As it may be necessary to contact you for further information, ”
“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 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”
“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 ”
“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”
“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.”
“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”
“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 •”
“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”
“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”
“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 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”
“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”
“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”
“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 ,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”
“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”
“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”
“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 ”
“__ ___________ - 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”
“):vRs A Catherine Hylander 11965 Goinsboro Rd. wave you EXECUTEDA POWER or ATTORNEY -. YES: Rockvil e, Md. P.no.-(lt*Yes"swho possess the power.ot attorney’) 06. ADDITIONAL DATA AND/OR CONTINUATION OF PRECEDING ITEMS SIGNED AT DATE Tisge Tarme Fry CONFIDENTIAL”
“. ' 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”
“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 (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”
“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”
“1 4-00000 1104-10106-10217] 2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992 Standard N.V.B.T.L. Fur, i-lOM Mortgage Note, individual or Corborron. (Straight Of tostalreint. CONSULT YOUR LAWYE2 RE SIGNING THIS INSTRUMENT — THIS INSTRUMEN JUL”
“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”
“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”
“. , DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE SOCIAL SECURITY ADMINISTRATION Bureau of Old-Age and Survivors Insurance. 0 EXAS- Form approved. *~.e Budget Bureau No. 72-R094.11. APPLICATION FOR SURVIVORS INSURANCE. JAN BENETJ3#* (Do not write in this space) All item”
“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 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”
“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”