◆ SpookStack

ian.d CLAIS FOR UIAID CORMPENS/TION OP DECEASED CIVHLIAN EMPLOYEE (NO DESIGN/.TFV BENEFICIARY OR SURVIVINC SPOUSE) 1. I/wy, the undersigned, herehy mahe claim as.. Executor for amounts due from the (Relaticnshi United States o th. District of Columbia in the case of ...John..Edgar. lloover.. (Namc of derrdnt 19.72.. -State tf . and was employed by the United States or the District of Columbia as follows: Fed.ral Trcnu of Investigation. ar 3. The deceased is survived hy the following:. Widow or widower (if nole, so state) :. Name euou Children (Show' each living child of the deceased. If none, so state) :. Name of Chilil Age Street Address, City, State, and ZiP Code nonc Grandchildren (List only the children of deceascd children. If none, so state) :. Name, Age, Strec! Address, City. State, and ZiP' Code. Name of Deceased Parent none 4. If no widow or widower, child or grandchild survives, enter bclow the nane and address of each survivin! parent, and state: whether natural, step, foster or adoptive parents. (lf nonc, so state.) Nume of Parent Strect Address, City, State, and ZIP Code Mother. not Father none