Part 18, page 101
FBI 164-81, Vault Part 18 p. 101 (DB Cooper-5434), Form — cooper.theunsolved.net/parts/Cooper-Part-18/pages/101
Transcript
The scan is the source; the transcript is machine-generated from it.
——— Please Print ——— Policy Number A 058898 PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $20,000 Capital Sum (Scheduled Air) $10,000 Principal Sum (Other Acc.) PREMIUM $ [guess: 2.15]
BAGGAGE AND PERSONAL EFFECTS $NONE Amount of Insurance PREMIUM $[guess: 4/0/15]
COMBINED PREMIUM $________ Term of Coverage: 10 Days
Name of Insured [REDACTED] b6 Address of Insured [REDACTED] b7C City Portland State Ore ZIP Code Name of Beneficiary [REDACTED] Address of Beneficiary [REDACTED] City [illegible] State [illegible] ZIP Code
Effective at: Hour 8:30 [x] a.m. Date 11 - 23 - 71 ☐ p.m. Month Day Year Place [guess: PDX]
Personal Signature of Insured _______________ AGENT CO[PY]
---
——— Please Print ——— Policy Number A 058900 PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $20,000 Capital Sum (Scheduled Air) $[guess: 10],000 Principal Sum (Other Acc.) PREMIUM $ [guess: 2.15]
BAGGAGE AND PERSONAL EFFECTS $NONE Amount of Insurance PREMIUM $NONE
COMBINED PREMIUM $________ Term of Coverage: 10 Days
Co[illegible] Li[illegible]
Na[me] [REDACTED] b6 Address of Insured [REDACTED] b7C City [guess: Milwaukee] State [guess: I mN] Code Name of Beneficiary [REDACTED] Address of Beneficiary [REDACTED] City [illegible] State [illegible] ZIP Code
Effective at: Hour 11:00 [x] a.m. Date 11 - 23 - 71 ☐ p.m. Month Day Year Place [guess: PDX]
Personal Sig[nature] of Insured _______________ AGENT COPY
---
DB Cooper-5434