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( ( UNITED STATES DEPARTMENT OF JUSTICE FEDERAL BUREAU OF INVESTIGATION In Repiy, Please Refer to - File Nv. Lire ct ¢ Feqery! © ureau ee ella tain “eater Pt te ss 1D eotocert Cf Coates Wo, Pye . ‘ Dear our the ot Toke pauld t othe designated beneficiary of any Specugl Agent co: ine FM) whe hus previously ~ thot . ao shows chats tp a fuse ex ep! pelfedestruction whi employed gs 4 Special Agent, lam for- amit cteadt. thy Check - Money Order) th. of $23, payable tc S.A.1.F., te Le included in said tund. Fayment will be : qeooue Dletestr. ¢ ther th daest has beers ao member oe! the fund far 4 contanulus Period of two years. [tas ar . feet A othatou wil tet dened herewith as ou voluntary, geotulteus contribution to said fund which | understand an a Farm the tag) warren oaunre gr wee ot, sEthe Filo owell appoit a committee which shall consider atl matters pertaining to the adequisitio:., safe keer udoeryp ay of saad tand, which tommittee will recommend appropriate actian to the Girector in pertinent matters. The #4 atone f ‘foot tne Adianistrative Division of the FBI shail receive al! rontributiens and geceunt for same ig the Dare t Ins . terh fo ang Specaual Agent who is aq member of maid fund the apy; ointed conn:ttee will conside: tre 7 dae nd surcctogore Peas t. Mie Larector as 19 ite conclustons, Approrriate inatructionse will then be issued te the A saist- wer : a vines ative taivision, directing him to pay to the designated beneficiary the sum of $10,000, Tie diabibity the turd sia ander any circumstances ercaed the amount of monies in the fund at the time any liability shall occur, EXECUTE IN DUPLICATE AND SUBMIT BOTH COPIES TO THE BUREAU (cia) Bureau Nar case type or print) | Office of Assignment lor SOG Division! ~A 0. = > Zoover Office of the Director ro - folluwing perso: .G6ignuted aus wy beneficiary for Special Agents Ineurance Fund: “ane (prim. beneficiery: uge given Noo. leontingent benef. ‘ary, if desired: use given firet name if female! Relationship vat desir, tu desig ne the above-listed beneficiaries as the beneficiary and contingent beneficiary respectively of the esp mn Heee Fund: sell? > Yes [] No If not, the entire following portion must be executed. " The - tlowing .-+-on is designated as my beneficiary under the Chae. S. Roes Fund providing $1500 death benefit to wenefiiiar "agents k''ted In the line of duty, ether than travel oceldents. Nutne (prima. beneficcary; use given first nume if female! Relation ship iddire 8s Sloe Looants gent bene” Clary, if desired: use given firat name if female} Relationship ‘ress Very truly yours, We eR ST ee pater see eae ee OT eon i aa eae