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UNITED STATES DEPARTMENT OF JUSTICE FEDERAL BUREAU OF INVESTIGATION In Reply, Please Refer to July 26 . 1963 File No. Direct. - _ Pederv. tsureag ct ls westy ator United States Tie: -cmert of Justice Washington, [), bea: ctr: Toit woe Tenet be be paid to the desiguqted beneficlary of any Speoud) Agent of the FHI who hag previousiy otttag ot ot ot ' fused and wie dies trom qny eduge except seif-destruction whale employed as a Special Agent, |} am for- warding tereowlt €by Check - Money Order) th: sun. of $10, piyubte te S.A,1.F + fo be inciuded in said fund. Payment will oe Rode toro deorth py edited otru chun after the Agent has been ag omember of the dund fer a continuous period of two years, Jt is anacdert vodoey bored that the sun fendered herewith if uo voluntary, gratuifeus contribution to said fund which ! understand de tet adn.rrd 7 an the tollawing Manner, The jute ef the FR] will appoint @ committee which shal! consider all matters pertaining to the acquisition, mate keeping and ex. vy of eed fund, which committee will recommend appropiate action tu the lyirector in pertinent niatters. The Assistant Corowd the Aduanistrative Division of the Ft shai) receive all contributions ind account for same to the Syrpestoc. Wp or Jeath ol any special Agent who is a member af @aid fund the appointed comnittee will consider the case aod sub ut ate vo endation to the Director os to its conclusions. Appropriate instructions will then be imsued to the Aamist- gnt iairector ot tre Aamuniétrative ioivigion, directing him tu pay to the designated beneficiary the sum of $10,000, Tie trability cf the tund sho ‘under any circumstances exceed the amount of monies in the tund ot the time any Iiability shail occur. EXECUTE IN DUPLICATE AND SUBMIT BOTH COPIES TO THE BUREAU Othieral Bureau Namy (please ype or print) Office of Assignment for SOG Division) s\ J. Edgar Hoover “40° The following person ts designated us my beneficiary for Special Agenta Insurance Fund: “Name (primary beneficiary; use given first name if female} _..keatate “ddregs Relationship ‘ame (contingent bene ficiury, if desired; use given first name if female) Relationehip Addrestb rr The following jerson is designated as my beneficiary under the Chas. S. Roes Fund providing #1500 death benefit to ovheficiury of agents killed in the line of duty, other than travel cecidents. _ Estate Name (primary beneficiary; use given firat name if female) Relationship As. irene Name (contingent bene fir lary, if desired; use given firat naine if female) | Relationship ; Address” ~ Very truly yours, reyinent Received Spe. Asents Insurance Fund J. Edgar Hoover, Director — reer Special Agent Creare an © ike. Vy ree 5, k, a figover, virector ae - &mbm a ce age orton ag Ee TL nT Tm Se Parearereein cpg epee eee epee te em we me tecan mea ob Ft Sen FO AE EY :