Part 114, page 45

Transcript

The scan is the source; the transcript is machine-generated from it.

VETERANS ADMINISTRATION Insurance Form 336 (Revised Nov. 1942)

A SEPARATE FORM FOR EACH POLICY ON WHICH A CHANGE OF BENEFICIARY IS DESIRED

POLICY No. N ____________

CHANGE OF BENEFICIARY—NATIONAL SERVICE LIFE INSURANCE

I, the undersigned insured, hereby cancel all previous designations of beneficiaries under the above-numbered National Service Life Insurance policy and direct that said insurance, which amounts to $________________, be paid from and after my death as follows:

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GIVE COMPLETE NAME AND ADDRESS OF EACH BENEFICIARY RELATIONSHIP AMOUNT OF INSUR- (NOTE—If a married woman, her own first and middle name (Must be stated) ANCE TO BE PAID TO and husband's last name must be stated) EACH BENEFICIARY

PRINCIPAL: Mrs. Catherine Miles [illegible - $[guess: 10],000 1527 N. 9th Street obscured by Santa Ana, California stamp]

Mr. Schuyler U. Miles, Sr. Father 142 Covina Ave, Long Beach 3, California -OR- CONTINGENT: Mrs. Hilda Miles Mother 142 Covina Ave, Long Beach 3, California

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CAUTION: SPECIAL HANDLING REQUIRED This material copied from Personnel Records Center, St. Louis, Missouri. To be used for reference only. Do not recopy or disseminate its original form outside the Bureau.

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Signed at ___Naples, Italy___ on this, the __24th__ day of __[guess: January]__, 19[illegible]

Signature Signature of witness: [handwritten signature] of insured: [handwritten signature]

H. S. BURNS (Print) SCHUYLER E. MILES, Jr. WOJG, USA, 803 [guess: IP] Bn [guess: CpSgt]/Ehq 803 IP [guess: Bn] (Rank and organization if in service) (Rank and organization if in service)

Address: Headquarters Detachment Address: Company O, (Street and number) (Street and number) 803 [guess: UP] Bn, APO 782, U.S. Army 803 [guess: NP] Bn, APO 782, U.S. Army (Post office and State) (Post office and State)

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This form, when completed, should be forwarded immediately to the Veterans Administration, Washington, D. C.

Signature of insured should be in ink and witnessed by a responsible and disinterested person. The rank and organization of the insured and the witness should be stated if the insured is in the military or naval service.

The insured, under a National Service Life Insurance policy, may designate a beneficiary or beneficiaries of his insurance within the following classes only: Wife (husband), child (including an adopted child, stepchild, illegitimate child), parent (includ- ing parent through adoption, and persons who stood in loco parentis to the insured at any time for a period of not less than 1 year prior to entry into active service), brother or sister (including those of the half blood) of the insured.

The insured may designate any person or persons within the permitted class as contingent beneficiary or beneficiaries, who will take the monthly installments of insurance if the principal beneficiary or beneficiaries should not survive so as to receive any installment or installments of insurance, or take any remaining monthly installments if the principal beneficiary or beneficiaries survive the insured and receive one or more monthly installments but die before all installments certain have been paid.

A stepchild or illegitimate child cannot be paid benefits under the National Service Life Insurance Act of 1940 unless spe- cifically designated as a beneficiary by the insured.

The proceeds of a National Service Life Insurance policy shall not be assignable and the payments of National Service Life Insurance as such are exempt from taxation, but such exemption does not extend to any property purchased in part or wholly out of such payments.

(See reverse side for further information as to beneficiaries and manner of payment of death benefits). 16-21039-1

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DB Cooper-10667