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

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1?7283.
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1? 7283
FILE No.
BENEFICIARY SLIP
File No. ______
_! ~WHOUSE. D~ll;J_~_:r:.t......GJ eroent
(Name of ofllcer ; surnamefirst)
E n s i g n _.J-_JJSN__________
(Rank and corps)
____________ 1 9 Aug:u e _t.__194.4__________________
(Date)
If your status has chani:cd from " no dependents" to " dependents"
(or vice versa) siucc IO!Jt report, indicate b:, v' in this spnco O
- l b===
=
=
=
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REPORT OF DEPENDENTS UNDER ACT
OF JUNE 10, 1922
tlre.-The Act of J une 10, 1022, defines the term "dependent..
as a lawful wife, unmarried children under 21 years of age, or the
mother of an officer provided she is in fact dependent on him for
her chief JiUl>port.)
Number _____
Yes
Mother ---------------------------------------------­
(Yes or No)
Yea
Wife------------------------(Yea or N'o)____________________ _
Age and sex of each child under 21 years of age:
M:il e
6 yr s.
Female
4 yrs.
I
GPO
l o--88831"""2
Name~ ~ :~ -~ !!_?..~_L__J?_Q):_9-~_:r:L Cl ement .
(Name in full, surname to the loft)
Serial No. i _?._72 §-9________________________________________
(File number, not aignal nwnber)
Ship or
NAS
station
. (Name)
------ --- ------­
C!?_~9 _§Q!-:9___Q_ _~ ~--------J:~ Aggu.at __l9_ti
(Date)
Under the p1·ovfaione of the Act approved May 22, 1928, ae e.-,:­
tended by t he Act of March 17, 1941, directing the p'\yment of 6
months' pay to the wido,v, children, or dependent relative of any
of the personnel on the active list of the Regular Navy or on the
retired list when on nctive duty, or of any o! tho pereo~nel of the
Naval Reserve called or ordered into active naval service by the
Federal Government for extended naval service in excess of 30
days, who dies of wounds or disease not the result of hie or her
own rweconduct, I give below tho name and address of my wife
and that of each of m11 children:
(See instructions on reverse side)
NO _.Q_ij.PJ.~G_E_.S.I!lCE__.LA.ST__RE.P_QRT _______ _
(Full name of wife; if not married, so state)
(Address pf wife)
-------­
(Full name of child; if none, 80/tltate).
(Da~·or birth)
(Addre511 of child).
---------­
(Ad~ess of childl -
---------­
(Full name of child)
(Date of birth) •
(Address of child)
In the event of my leaving no widow or child or of
their decease before payment is made, I then desig­
nate as my beneficiary under the said Act the follow­
ing relative, my
----­
(Relationship)
----­---­ -
-
(Name in full)
- ­ - ----­----­--­
(Address)
________________L_______
* _____________________-__-__- __-_-__
-_-__-________________
I
• If the beneficiary named above is your father, mother, brother,
or sister, you need not fill in these three lines. If the beneficiary
le n more distant relative, such ,as a grandparent, state briefly
wherein dependency exists, such as " allotments registered,"
"mont hly contributions byGovernment check," indicating amounts
and r egularity thereof,
[OVER]
l&--33831-2
REPORT OF NEXT OF KIN
NEt1HOUSE..,____Del bert __ Clemen~t __
(Nameofofficer, surname first)
--~l.£LAugu,_s_t___l~144 _______________________
(Date)
Any change since last report:
~orNO
(Strike out one; if no change, do not fill out remainder of this
report.)
Name of next of kin ______________________
_,..____ ___..__ __·- - ---- ---------------------­
(Rclationsblp)
Permanent residence:
Street and No. __ ___________________
City or town --- --·--- ----
Staw _ _ ___ _________
Emergency address:
Street and No. _ _ _____
City or town----- --- --------------·­
State - -----·------
·- -------------·
--------- (Signature)
-------- -------------­
------------- (Rank and corps)__________________________
GPO
1&-38831-2