Final Personnel Record for Newhouse, Delbert C., U.S. Navy, 1957

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DATA SHEET TO ACCOMPANY CLAIM FOR REIMBURSEMENT OF DEPENDENTS' TRAVEL

(All entries to be made by the claimant in ink, in his own handwriting)

The following data is submitted in substantiation of my claim for reimbursement for travel performed by my dependents:

MEMBER'S FULL NAME Dolbert Clement Newhouse 177283 CPHOT (First) (Middle) (LAST) (Service No) (Rank/Rate)

DUTY STATION Utility Squadron F/VE PHONE NUMBER 14-21282

WIFE'S NAME Norma / Isobel Newhouse Date of marriage 8/7/36 06

CHILDREN'S NAMES: RELATIONSHIP DATE OF BIRTH
Delbert Carroll Newhouse Son 6/28/38 06
Anne Lisbet Newhouse Daughter 3/14/40 03

** Step children or adopted children must be classified as such. Dependent parent must be classified and claimed as such.

"I certify that my dependents were located at 1948 Derby St, Berkeley Street Address, City

Calif when orders directing detachment from my old permanent station State
were received, and departed from that place on 6/14/54 Date

** ** ** ** ** ** STRIKE OUT IF NOT APPLICABLE ** ** ** ** ** **
and arrived at (Point of Selection) 35-81 SE Grant Court, Portland, Oregon on Street Address, City State
6/14/54 . and departed from that place on Date

** ** ** ** ** ** ** ** ** ** and arrived at San Francisco, Calif on ** and departed there on Date
** ** ** ** ** ** and arrived on Guam, M.I. on ** Address on Guam Date

Complete address

"I certify that my dependents were last transported or reimbursed at Government expense for travel to Oakland, Calif. City, State".

NOTE: This data sheet is to be presented to the disbursing officer with the original and three certified copies of travel orders, with all endorsements. The "Voucher for Reimbursement for Expenses Incident to Dependent Travel" (NAV. S. AND A. FORM 912 Rev.) will be signed when completely filled in. This "Data Sheet" or the "Voucher for Reimbursement for Expenses Incident to Dependent Travel" (NAV. S. AND A. FORM 912 Rev.) will not be signed in blank.

"I further certify that all entries made above are in my own handwriting and are true and correct; that I have read this completed data sheet and understand that any misrepresentation or concealment of material fact by me may work a forfeiture of the claim and subject me to trial by court martial or Federal District court and to penalties extending to five years imprisonment or $10,000, fine, or both".

D. Newhouse
(Signature of Claimant)