◆ SpookStack

CTS Fa > ( (> UNITED STATES DEPARTMENT OF JUSTICE FEDERAL BUREAU OF INVESTIGATION 3, a fn Reply, Please Efer to . Fil. No. ibe rod po bvore . “nove .gutiorn ait tbe. ‘ttmens oi Justice n i 7 . at trent ot 7 oar the rar dot be patd t the designated beneficiary of any Upecial Agent of the FRI whe has previ. us: soe par doa do ow Gatu frot amy cause except Self-destruction wiiile employed as a Special Agent, T uin f. wor: ro: (by Check - Money Order} the sun of $20, payable to S.ALILF., 1) be included in said fund. Payment wit). ‘ sediedr stricta ather the Aqent has beer or member of the dund for da contunucus period of two years, [1 -. that fh. sun fendered herewith rs ou voluntary, a7oturteus contobution to paid fund which I undersra:.: roan the following mannet. The Do cer ad the FET wall appoint a committee which shal] consider ali matters pertaining to the aequigition, sate Kee guna and x rng of said turd, which committee wil] recommend appropriate action to the Dtrector in pertinent matters tte Grossi Ulrectar of the Administrative Division of the Fb! shall receive al] contributions and account for same tu th. ir ne “} yeath of uny Special Agent who is o member of soid fund the appointed cunnittee will consider the case SoC osutctor st coendation to the Director 06 to its conciueions., Appropriate instructiong# will then be issued to tne Assis at coe. Adnmicnietrative Jivision, directing him to pay to the designated beneficiary the sum of $20,000, The fiabii:ty foe. tur: ,obetoander coy circumstances excevd the amount cf monies in the fund at the time any liability shali cecur. EXECUTE IN DUPLICATE AND SUBMIT BOTH COPIES TO THE BUREAU ‘ae a uw. “ t - 14 es at Tay a oe re : a of ores ors : . . fieia! Bureau New: please type or print} Office of Aegsignment tor SU Division! { rr The following person is designated as my beneficiary for Special Agents Insurance Fund: Relationship Name (primary beacfictary: use given first name if female) .. Clyde Aa.*Zoalson — Aridre ss Nume ‘c Ciingent beneficiary, if desired; use given first name if female) | Relationship i address Lk. vou ce-ire to). gnate the above-listed beneficiaries as the beneficiary and contingent beneficiary reapectively of the Chas ™ Ross Fees as well? Og Yer CI] No If not, the entire following portion must be executed. TL. follow:ng person in designated as my beneficiary under the Chus. 8. Ross Fund providing $1500 death benefit to beneficiary of oge-*s killed In the line of duty, other than travel accidents. Ciyas_A. Tolgon _ Name (p:ruary ben--ficiary; use given first name if female) | Relationship Addre se Name (contingent beneficiary, if desired; use given first name if female) Relationship Addtes ‘ —— Payment Kecewed Very truly yours, mn de man, fee, eaume . Enna apteisl Atle HIthidlite FER a a Piao