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an lee aa PRE ct FIRE rm ier Maciel 3. “Cite Ingres SRR UNITED STATES DEPARTMENT OF JUSTICE — FEDERAL BUREAU OF INVESTIGATION In Reply, Please Refer ta March 12, 1965 File No, - Dee or Ped oetti Bureau investigation United btutes D+. uttment of Justice Wash. tomy bey . Olaf Dear si': PeePoan avad oan the fund te be puid to the desiqnated benelictary of any Special Agent of the F BE who has previously Conttisctet ote tha: tund and owho dies from any cause cxcept self-destruction while employed as a Specia! Agent, Tam for- wurdi:- herewtt) (by Check - Money Order) the sum of $10, payable to 5.A.1.F., to be included in said fund. Paement will be made ‘or death ov seit-edestructi.n affer the Agent has been a member of the fund fora continuous period of two years. It is Lraerst wt art cacsed that the sum tendered herewith 18 a voluntary, gratullous contribution to goaid fund which I underatand geocte oe Admarngst) doar the foilowang manner, The Dare Jict of the FBI will appoint a commitiee which shall consider all matters pertaining to the acquisition, aate keeping and ex;-cding of paid fund, which committee will recommend appropriate action io the Director in pertinent matters, The Agsistant ! -tor of the Administrative Division of the FBI shali receive all contributions and account for same to the Directs. Upor death of any Spectral Agent who is @ member cf said fund the appointed committee will consider the case qgad submit arec +7 endation to the Director aa to its conclusions. Appropriate instructions will then be issued to the Aesisi- ant Director of the Administrative Division, directing him to pay to the designated beneficiary the gum of $10,000, The liability of the fund sho: -5t under any circumstances exceed the amount of monies in the fund at the time any liability ahall occur. EXECUTE IN DUPLICATE AND SUBMIT BOTH COPIES TO THE BUREAU Official Bureau Name (please type or print) J, Edgar Hoover Office of Assignment (or SOG Division) Seat of Government SA The following Person is designated as my beneficiary for Special Agente Inevurance Fund: Name (primary benefic ary; use given firet name if female) Estate “ame (contingent beneficiary, if desired; use given first name if female) | Relationship Address Relationship wou destre to des st te the about listed beneficiaries as the beneficiary and contingent beneficiary respectively of the whey sk -5 Func well? Ci Yes [7] No If not, the entire following portion must be executed. The foltowing person is designated as my beneficiary under the Chas. 8. Rosa Fund providing #1500 death benefit to beneficiary of ogents killed in the line of duty, other thon travel accidents. Relationship Name (pri ary beneficiary; use given firat name if female} 7 : Estate cddre as Veme (contingent benefiriary, if desired, une given firet name if female! Relationship : iddresa - Very truly yours, —_ —_ Aa REST: big ie eee Ve, FAA ORM a ear meme SEU Se gee Np TRENT RE Le eT TEENS oe . Sp ape es a eee eT ay