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FD-253 (Rew. @-7-5/) ( UNITED STATES DEPARTMENT OF JUSTICE FEDERAL BUREAU OF INVESTIGATION In Reply, Please Refer te WASHINGTON 25, D.C : File Ne. Director Federal Bureau of Investigation United States Department of Juatice Washington, D.C. RES tor (Type or priat plainiy) Dear Stir: For Inclusion in the fund to be paid to the designated beneficiary of any Special Agent of the FBI whe hae win eee eeilebe ad an the #...40 =a me aoe eee ee eee 1 8. 21 t —T viously conifibuted to this fund and who dias from any cause sxcepi seli-desiruction while employed as a Special agent, > forwarding herewith (by CHECK - MONEY ORDER) the sum of $10, payable to the Assiatant Director, Administrative Division, FBI, to be included in sald fund. Payment will be made for death by self-destruction after the Agent has been a member of the fund for a continuous period of two years, It ie understood and agreed that the eum tendered herewith is a voluntary, gratuitous contribution to said fund which | underatend is to be administered in the following manner. The Director of the FBI will] appoint a committee which shall consider all matters pertaining to the acquisition, safe keeping and expending of sald fund, which committee will recommend appfopriate action to the Director in pertinent motters. The Assistant Director of the Administrative Division of the FBI shall receive all contributions and account for same to the Director. Upon the death of any Special Agent who ia a member of said fund the appointed committes will consider the case and submit ¢ recommendation to the Director ame to ite conclusions, Appropriate instructions will then be lesued to the Assistant Director of the Administrative Division, directing him to pay to the dealgnated beneiiciary the sum of €10,000, The liability of the fund shai] not under any circumstances exceed the amount of monies in the fund at the time any liability eball occurs. The following person is designated as my beneficiary for FBI Ageote’ Insurence Fund: Name Relationship Date Estate Address The following person is designated as my beneficiary under the Chas. &. Rosas Fund providing $1500 death benefit to beneficiary of agents killed in the line of duty. Name Relationship Bate Estate Address wo, ~ Very truly yours, y ‘ ! a wk 2 eee ; we fh a, we op) meee pet eR Ce TEES rR chet TOE gh ESR eT eT nm a aan ane argmeras Per sarte ee TER aT ‘ a i 4 y re ree, oo a ol