◆ SpookStack

ee DD 1 SUL TOS ANS BCG 2529, WHICM MAY SE USED UNTIL 1 JANUARY 1952, WHEN THEY WILL ALL BECOME OBSOLETE. . ee eae een ee ase + Mee mac cid I Eo Ls! CS + Seer Fe PN AR A NS ele Prweid emerter ed , RECORD OF EMERGE? VATA FOR THE ARMED FORCE THE UNITED STATES -ENFORMATION INCLUDED sTHIS FORM DOES NOT DESIGNATE Qprntce BENEFICIARIES OF LIFE INSURANCE POLICIES (See ingtructions on reverse side of form priot to making entries) Le DESIGHATOR'S LAST NAKE-FIRST NAME-MIDDLE NAM = SERVICE NO, | 3. GRADE, RANK OR RA S.SERVICE TE) usa Co usn Booton, John Don RAL? 292 092 Ret C7 usar C] see CJ uses 5, FIRST KAMESMEOSLE NAME @tA NAMED RSOM TO SE NOTIFIED ER CASE OF EMERGENCY RELATIONSHIP Iftrtend, (Person with peraanen ao atate) Mother address ig advisabieX Enth Schneider AOORESS (Number, Street, City—andstate) = 905 W. Prairie Stes Marion, I12. TRE PERSONS NANED tTERS 6, 8, ANS J, SELOW WILL ALSO BE NOTIFIED OF THE EMERGENCY. [Ff SUCH NOTIFICATION 15 NOT DESIRABLE, OVE TO REAETE QR FOR OTHER PERTINENT REASONS, PLEASE SOSTATE UNDER FREMARKS ON YHE REVERSE SHOE. Oe. SPOUSE (First name, Middle Name, Leut sane or if deceased of divorced, so etate) None ADDRESS (Number, Street, City and State} CAUTION? SPECISE re This’ ; 4 ) (8 G ehaes ses pensnetrnihss P22 " ADRBESSavender, Street, City end State) mame, Last name) bs ny Ray Booton 905 ¥. Preirie Ste» Marion, Til. rat nene, wigdte nemo, Last name} (ara:Leora Booton SS ri OR ELIGIB Lid FORE PAYMENT OF 6 MONTHS GRATUITY 1§ MADE, |! YREN OESIRE THAT PAYMENT SE MADE 7} THE DEPENDENT RELATIVE SHOHN AOORESS (Nuwbers Street, City and State) 905 W. Prairie St., Marion, 111. IN THE EVENT OF CEATH OR DISQYALIFICATION OF TRE ASOVE NAMED DEPENDENT RELATIVE, 1 THEN QESIGNATE THE ALTERNATE CEPENDENT RELATIVE SHOWN BELOW. (Other than epouse or child) Rin FIRST WANE-MIDDLE NAMESLAST NAME on : ‘ ACTIVE SERVICE. (The "Policy Number® shoyld be entered ifpeseible, since this information will eoelet i én expes diting action by the inayvzance conpasy should « ciein dbecome payable, } (Coatinae on reverse side} in THE EVENT THAT I Ait LISTED AS MISSING, OR BY OTHER MILITARY CIRCUMSTANCE “Au UNABLE TO TRANSMIT FUNDS TO NY" DEPENDENTS, IT IS MY DESIRE THAT bee : 13. FIRST NARE-WIDDLE NAME @LAST RANE MATURE OF OESIGNATOR v/ DB Cooper-10227 REPLACES OD FORM 93, 1 YAN SOS NME FORM 93 2 OCT NGz NAV 220/115 POPE NAVPERS 692, PAGES 7 AND 6: