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

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ELECTION Of OPTl~S UNDER THE UNIFORMED SERVICES CONTINGENCY OPTION ACT OF 1953
NAVPERS 59 1 (HiW 0/53)
NAME
(La.st)
(Fi.rst)
(Middle) I
SERVICE NUMBER I
RANK OR RATING
usfl
USNR
CHPHOT
N M'.!UI' H( JI , ~ 1-t:
n"'lbert Clement
177283
I X I
PERMANENT ADDRESS
STATUS
NO. YEARS SERVI CE COMPLETED FOR PAY
CHECK APPROPRIATE SQUARE
PURPOSES
foMrs . Vencl Richter
REGULAR
RESERVE
ACTIVE
INACTI VE
24
Garibaldi, Oregon
DUTY
DUTY
MEMBER"S BIRTHDATE
:x:
6/5/13
[xi
I DO NOT DESIRE TO RECEIVE REDUCED RETIRED PAY IN ORDER TO PROVIDE AN ANNUITY FOR MY DEPENDENTS.
I ELECT T HE FOLLOW ING OPTIONS: (NOTE: YOU MAY SELECT OPTION 1 OR 2 OR 3 AND YOU MAY COMBINE OPTION 4 W ITH THE ONE SELECTED,
OR YOU MAY SELECT OPTIONS 1 AND 2 AND YOU MAY COMB INE OPT ION 4 W ITH EITHER OR BOTH. HOWEVER, THE COMBINED TOTAL OF c,1.
TIONS ELECTED CA NNOT EXCEE D SO% OF REDUCED RETIRED PAY,)
vi"
OPTION 1
1/a
□
¼
□
½
□
;;;­
er:
OF MY REDUCED RETIRED PAY PAYABLE TO OR ON BEHALF OF MY WIDOW UNTIL HER REMARRIAGE OR DEATH.
::,<
~ OPTION 2
1/a
□
¼
□
½
□
...
I­
OF MY REDUCED RETIRED PAY PAYABLE TO OR ON BEHA LF OF MY SURVIVING CHILD OR CHILDREN UNMARRIED A ND UN­
<
DER 18 YEARS Of AGE AND SURVIVING CHILD OR CHILDREN UNMARRIED AND OVER 18 YEARS OF AGE INCAPABLE OF
ii:
SELF SUPPORT BECAUSE OF BEING MENTALLY OR PHYSICALLY INCAPACITATED.
0..
0
er:g;
OPTION 3
1/n □
¼
□
<
OF MY REDUCED RETIRED PAY PAYABLE TO OR ON BEHALF (A) OF MY SURVIVING WIDOW UNTIL HER REMARRIAGE OR
~
DEATH AN D (B/ T HEREA FTER TO MY SURVIVING CHILD OR C HILDREN UN MARRIED AND UNDER 18 YEARS OF AGE AN D
u
SURVIV ING CH LOREN OVER 18 YEARS OF AGE A ND INCAPABLE OF SELF SUPPORT BECA USE Of BEING ME NTA LL Y OR
:z:
PHYSICALLY INCAPACITATED.
...
u
~ OPTION 4
NO FURTHER DEDUCTIONS SHALL BE MADE FROM MY RETIRED PAY COMMENCING W ITH THE FIRST DAY OF T HE MONTH
FOLLOWING T HAT IN WH ICH T HERE IS NO BENEFICIARY ELIGIBLE TO RECEIVE AN ANNUITY UPON MY DEATH. I DESIRE
z
THIS OPTIO N TO BE COMBINED WITH OPTION NUMBER(SJ,----~ -.,---·CHECKED ABOVE.
0
(insert numbers)
IMPORTANT: If any of the above options is elected tile following information m11st be f11rnislied :
FULL NAME OF SPOUSE
DATE OF BIRTH OF SPOUSE
FULL NAME OF WIFE PRI OR TO MARRI AGE
PLACE OF MARRI AGE
(City)
HAVE YOU BEEN PREVIOUSLY MARRIED?
□
YES
□ NO
HAS YOUR SPOUSE BEEN PREVIOUSLY
MARRIED?
□
YES
□
NO
(County)
(State)
DATE OF MARRIAG E
IF YES . GI VE DATE AND CITY. COUNTY. AN D STATE OF DISSOLUTION OF EACH FORMER MARRI AG E AND
STATE WHETHER BY DEATH. ANNU L MENT OR DIVORC E
IF YES. GIVE DATE AND CITY. COUNTY. AN D STATE OF DISSOLUTION OF EACH FORMER MARRI AGE AND
STATE WHETHE R BY DEATH. ANNULMENT OR DIVORCE
IMPORTANT:
Tf either optio11 2 or 3 is incl11ded iii your electio11, f11rnish required information below concerning legitimate child or children:
DATE OF BIRTH
NAME OF EAC H CH I LD
INDICATE I F STEPCHILD OR ADOPTED CHILD
/ understand that d11n"g any Period mbsequent to my transfer to Fleet R eserve or ret1rcme11t 111 wlizch I am not receiving ,·etired or retainer
pay I shall be required to deposit with the United States Treasury the amount that would /Jave been withl1eld from my ,·etired pay 1mder
the 'options e!ected had I bee1: receiving such retired pay, and if I fa!l to make such _deposi~ I cons_ent to che~kage of such undePosited amounts,
plus accrued mterest 11/)o!i being restored to a pay status; and that if I do not combine option 4 with the option selected, dedi,ctions will be made
from my retired pay dcsf)ite the fact that all beneficiaries predecease me or become ineligible for anmtity b
• s; and that in the case of retired
members, election of any of the options provided is irrevocable. I certify the
ve • ormatio11 to be c npl e and accurate.
Signat1ir ~c....:."""..:::.......:=:_
__..::J.....&o.a.~~!..-=~~:::Jl!-==:=--------­
Pies)
finished File Pers E-2"1
S11bsc • e and s
rn to before t e th' - ~~_,____day
of- -~'-'--=_;.;:;.__ __,
NOTED 'T' A-r, TTT A. 'l'F,D pF,l"'O~DS
* G. P . O . t 1093-2.7 3 402
7 ON REVERSE
(ORIGINAL)