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

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In the event of the death of the above-named beneficiary
before payment is made, I then designate as my beneficiary
under said act the following relative, my
____ii:2t.ruu:_____ ____ ____ _______________
(Relationship)
·---Darre11__Edwin__ Newhouse____________________________
(Name in full)
__ P.O. __:Sox_225, __ Garibaldi, __ Oregon _______________
(Address)
*
• In case of relatives more distant than your parent or brother or
sister, state briefly wherein dependency e..--.,;,ists, indicating amounts and
regularity thereof.
I CERTIFY that I will inform the Bureau of Naval Per­
sonnel immediately of any changes in marital status or
conditions of dependency.
I do solemnly swear (or affirm) that the facts stated and
disclosed in the foregoing are true to the be
f my knowl­
edge and belief.
----~~-~~~!Jjg)_____________, U.S. Navy,
(Rank)
~ft<Ja!Z
•
~
Subscribed and sworn to before me this _!_~-----==------­
day of __11~ -------------------, 19_±-5:I having author­
ity to adminiN eToaths.
~_A~qi~_~.'.'_~~~-----~~-t~~"~
INSTRUCTIONS
This form must be sworn to before an officer of the United States Navy
or Marine Corps authorized to administer oaths, or before a notary
public.
The full names and addresses of the beneficiaries must be stated care­
fully. If a married woman, her own given name should be stated; thus:
"Mrs. Anna May Smith," not "Mrs. John Smith."
This slip shall be made out and handled as follows:
Officer, Navy: Forward to Bureau of Naval Personnel.
Officer, Marine Corps: Forward to Commandant, Marine Corps.
Nurse: Forward to Bureau of Medicine and Surgery.
New beneficiary slips shall be executed and forwarded as above in all
cases of change in status of the grantor or in that of his or her bene•
ficiaries.
In any event, payment will be made to the widow or children, if any
whether designated or not, but not to a mother or other relative unles~
designated,
U. S. GOVERNMENT PRINTING OFFICE
10-32303-2