◆ SpookStack

2) Le ~ ee Y..2122D STATES DEPARTMENT OL-susTICE FEDERAL BUREAU OF INVESTIGATION - In Reply, Please Refer io File No, Direct t FPederag] bureau of investigation ‘Inated States 2: tment of Justice Woastington, L. Dear Sir: Foran ‘isron in the fund to be paid tu the designated beneficiary of any Special Agent of the FBI who has previously comtricuted t ' fenu and whe dies from any cauSe except seli-destruction while employed as a Special Agent, J] am for- wardieg herew:t: (by Check - Money Order) the sum of $10, payabie to the Aasistant Direcior, Administrative Division, FSI, to ke inctuded - said fund. Payment wil] be made for death by self-destruction after the Agent has been a member ct the fur.o ?.¢ + Conti: . uB petiod cf two years, Jt is understood and ayreed that the sum tendered herewith ig a voluntary, gratuitous Tontrilution te “a fund which I understand is to be administered in the following manner. The Dare cer of the Fb) will appoint a Committee which shall consider al] matters pertaining to the acquisition, sale K@cpeig und expending of said fund, which committee will recommend appropriate action to the Director in pertinent matiers, The Assistant T'.rector of the Administrative Division of the FBI shall recetve all contribullons and aecount for same to the Tureccor, Upor the death of any Special Agent who ia a member of gaid fund the eppointed committee will consider the case moasubmit rre rimendation to the Director oe to its conclusions. Appropriate jnatructions will then be issued to the Ausist- ant Datectur of t=) Administrative Division, directing him to pay to the designated beneficiary the aum of $10,000, The liabliity of the fung st i. uot under any Circumstances exceed the amount of monies in the fund ot the time any liability shall occur, EXECUTE IN DUPLICATE AND SUBMIT BOTH COPIES TO THE BUREAU Official Bureau Name (please type or print) Office of Assignment for SOG Division) x J. Hisar Hoover ~-11-6 The following person is designated as my beneficiary for Special Agente Insurance Fund: Name (primary beneficiary; use given fireat name if female) Relationship ___... Estate Address Name (contingent beneficiary, if desired; use given firat name if female} Relationship \ddress The following person is designated as my beneficiary under the Chas. S. Ross Fund providing $1500 death benefit to beneficiury of agents killed in the line of duty, other than traval accidents. Name (primary beneficiary; use given firet name if female) — Relationship Name (contingent bereficiary, if degired: use given first name if female? Relationship Addrese