Part 18, page 100
FBI 164-81, Vault Part 18 p. 100 (DB Cooper-5433), Form — cooper.theunsolved.net/parts/Cooper-Part-18/pages/100
Transcript
The scan is the source; the transcript is machine-generated from it.
Policy Number A 058895
PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $ 20,000 Capital Sum (Scheduled Air) $ 10,000 Principal Sum (Other Acc.) PREMIUM $ 7.75
BAGGAGE AND PERSONAL EFFECTS $ None Amount of Insurance PREMIUM $ [illegible]
COMBINED PREMIUM $________ Term of Coverage: 10 Days
Cou[nter] Lice[nse]
Name of Insured [REDACTED b6/b7C] Address of Insured [REDACTED b6/b7C] City [guess: Beaver] [guess: Fork] State Ore ZIP Code [REDACTED] Name of Beneficiary [REDACTED b6/b7C] Address of Beneficiary [REDACTED b6/b7C] City [illegible] State [illegible] ZIP Code [illegible]
Effective at: Hour 7:30 [X] a.m. p.m. Date 11 - 23 - 71 Month Day Year Place PDX
Personal Signature of Insured [REDACTED b6/b7C]
AGENT CO[PY]
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Policy Number A 058897
PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $ 100,000 Capital Sum (Scheduled Air) $ 50,000 Principal Sum (Other Acc.) PREMIUM $ 7.50
BAGGAGE AND PERSONAL EFFECTS $ NONE Amount of Insurance PREMIUM $ NONE
COMBINED PREMIUM $________ Term of Coverage: _______ Days
Cou[nter] Lice[nse]
Name of Insured [REDACTED b6/b7C] Address of Insured [REDACTED b6/b7C] City [guess: Beaverton] State [guess: Mi] ZIP Code [REDACTED] Name of Beneficiary [REDACTED b6/b7C] Address of Beneficiary [REDACTED b6/b7C] City [illegible] State [illegible] ZIP Code [illegible]
Effective at: Hour 8:00 [X] a.m. p.m. Date 11 - 23 - 71 Month Day Year Place PDX
Personal Sign[ature] of Insured [REDACTED b6/b7C]
AGENT [COPY]
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DB Cooper-5433
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b6 b7C