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a A ada ( UNITED STATES DEPARTMENT OF JUSTICE FEDERAL HUREAU OF INVESTIGATION In Reply, Please iv fer to File No. : . CHANGE OF BENEFICIARY ONLY JUN 6 196/ , Fed dure roinveagpotiin “rape States oo reiment of (ustice car tobe petaet ei ted benedtiswiry of any opecial Agent ' the Fis] who baw praviou : 1a. te koepr pevtedestruction whale employed a6 9a Specigl Agent, toagm io. rd root tby Check - Money Order} to sam ot Bo, paryabie oc. UALLP bo be giciuded in said fuad. buyiment will te ‘ Jifer Auent ha. wert a member of the fund {ofa centanulu. period of two years, ft :: 4 : 2 ot enoder dered herewath ts: woluntaury, gtgluricus contribution to said fund which ! underetqd.? Wir Tnarpryery ire? Soros the Prfl will appuint a committee which shajl consider aji matters pertaining to the acquisition, Bafe ker cond , fing vf said fund, which committee will recommend appropriate action to the Director in pertinent matters. The A “chroot the Administrative Division of the Fu! shail receive al! contributions and aecount for fame to the “+ tetho ot any Special Aqent who if a member of asid fund the appointed committee wil! conbider the cus: de ahs Daendar a ot. the Director as to ite conclusions. Appropriate inatructions will then be 1esued to the Assis? art cre. tot Adnonistrat ve Division, directing hin to pay to the designated beneficiary the sum of $20,006. The liability (toy tur dos! Jor to under any Cifcumstances exceed the amount of monies in the tund at the time any Miahi‘ity Bhali occur, EXECUTE IN DUPLICATE AND SUBMIT BOTH COPIES TO THE BUREAU Official Bureau Nic ‘please Lype or print? Office of Aseignment for SOG Division) J. EDGAR HOOVER, DIRECTOR Director's Office aA The fol- vaiDg persor te designated 46 my beneficiary for Special Agents Insurance Fund: ~ wate { primary ben * lary; use given first name if female) Relationship . Clyde A. Tolson Associate Ate "Th ake ~ OO 4000 M: ssachusetts Avenue, Northwest, Washington, D. C. (Apt. 1316) Name ontingent Yoeri, «ficiary, if desired; use given firat name if female) Relationship a SNddre s+ De vou uesire to de wnule the above-listed beneficiuries as the beneficiary and contingent beneficiary respectively of the “ois. S. Roes Fount - well? X: Yes (>) No If not. the entire following portion must be executed. fhe follow'n person is designated as my beneficiary under the Chas. §. Ross Fund providing $1500 death benefit to veneficiary of agerts killed fn the line of duty, other than trovel accidents. Name (primary be 7 SAME firat name if female} Relationship \ddrews 7 Name tc ontingent te sve fie lary, if desired; use even feet name femele) | Retemete Address Oo —_iia Very truly yours, ° Speci