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OR pt eae a ry ; {2 PD-252 (hev, $-. 2-0 4) { ( ae UNITED STATES DEPARTMENT OF JUSTICE —_— FEDERAL BUREAU OF INVESTIGATION In Reply, Please Refer File No. ° June 7, 1965 . Director Federa: Bureau of Investigation United States Department of Justice Washington, D. ‘, 20535 Dear Sir: For inclusion in the tund to be pald to the designated beneficiary of any Special Agent of the FBI who has Previously contributed to this fund and who dies from any cause except eeli-deatruction while employed as a Special Agent, { am for- warding herewith (by Check - Money Order) the sum of §10, payabie to S.A.1.F., to be included in said fund. Payment wail be made tor death by selt-destruction after the Agent has been a member of the fund fora continuous period of two years, Jt is understood and ayreed that the sum tendered herewith is a voluntary, gratuitous contribution to said fund which I understand ia to Le administered in the following manner. The Director of the FBI will appoint a committees which shall consider ail matters pertaining to the acquisition, sale keeping und expending of satd fund, which committee will recommend appropriate action to the Director in pertinent matters. The Assiegtont Isirector of the Administrative Division of the FOL shall receive ali contributions and account for same to the Director. Upon the decth of any Special Agent who is a member of said fund the appointed committee will consider the case and submit a recommendation to the Director aa to its conclusions. Appropriate instructions will then be issued to the Aasiat- ant Director of the Administrative Division, directing him to pay to the designated beneficiary the sum of $10,000. The liability of the fund shail not under any circumstances exceed the amount of monies in the fund at the time any liability shall occur, EXECUTE IN DUPLICATE AND SU8MIT BOTH COPIES TO THE BUREAU Official Bureau Name (please type or print) female} Relationship Name ‘(primary beneficiary; use given first name i Estate Address Name (contingent beneficiary, if desired; use given firat name if female) | Relationship Address the above-listed beneficiaries as the beneficiary and contingent beneficiary respectively of the 1? (() Yes [(j}No If not, the entire following portion must be executed. The following person is designated as my beneficiary under the Chas. 8. Rosas Fund providing $1500 death benefit to beneficiary of agents killed In the line of duty, ether than travel eccidents. Estate Relationship Paymert Received Special Agents-tnsusance Fund | ~ JU 91965 J. Edgar Hoover, Director ‘ “ COMET TR. TS prrr mT TTT are