Part 18, page 108
FBI 164-81, Vault Part 18 p. 108 (DB Cooper-5441), Form — cooper.theunsolved.net/parts/Cooper-Part-18/pages/108
Transcript
The scan is the source; the transcript is machine-generated from it.
Policy Number A 32700 PERSONAL ACCIDENT AND SICKNESS Amount of Insurance $ 15,000 Insured Only Premium $ 8.65 Dependent Premium $ 3.50 TOTAL PREMIUM $ 12.15
BAGGAGE AND PERSONAL EFFECTS $ [illegible] Amount of Insurance PREMIUM $ [illegible]
COMBINED PREMIUM $______ Term of Coverage: 14 Days
Co[untersigned by] ______ Lic[ensed] ______
Name of Insured [REDACTED b6/b7C] Address of Insured [REDACTED b6/b7C] City Oregon City State Ore ZIP Code [blank] Name of Beneficiary [blank] Address of Beneficiary [blank] City Barksdale AFAB La. Code 71110 Effective at: NOON Hour 12:00 PM Date 11 - 24 - 71 Month Day Year Place PDX Personal Signature of Insured X [signature present] AGENT COPY
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Policy Number A 059972 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: 2 Days
Countersigned by ______
Name of Insured [REDACTED b6/b7C] [guess: Occupation] [REDACTED b6/b7C] Address of Insured [REDACTED b6/b7C] City Portland State Ore. ZIP Code [blank] Name of Beneficiary [REDACTED b6/b7C] Address of Beneficiary [blank] City Portland State Ore ZIP Code [blank] Effective at: Hour 6:50 PM Date 11 - 24 - 71 Month Day Year Place PDX Personal Signature of Insured [signature present] AGENT CO[PY]
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DB Cooper-5441
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b6 b7C