Part 18, page 111
FBI 164-81, Vault Part 18 p. 111 (DB Cooper-5444), Form — cooper.theunsolved.net/parts/Cooper-Part-18/pages/111
Transcript
The scan is the source; the transcript is machine-generated from it.
Policy Number A 33266 PERSONAL ACCIDENT AND SICKNESS $ 20,000 Amount of Insurance Insured Only Premium $ 5.25 Dependent Premium $ 1.60 TOTAL PREMIUM $ 6.85
BAGGAGE AND PERSONAL EFFECTS $ none Amount of Insurance PREMIUM $ none
COMBINED PREMIUM $ ______ Term of Coverage: 5 Days
Countersigned by ____________________________
--- Please Print --- Name of Insured [REDACTED b6/b7C] Occupation [REDACTED] Address of Insured [REDACTED] City Portland State Ore. ZIP Code [blank] Name of Beneficiary Estate of insured Address of Beneficiary [partially legible] ZIP Code [blank] City [illegible] State [illegible]
Effective at: Hour 7:45 [X] a.m. [ ] p.m. Date 11-24-71 Month Day Year Place PDX Personal Signature of Insured [REDACTED] AGE [REDACTED]
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Policy Number A 059976 PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $ 20,000 Capital Sum (Scheduled Air) $ 16,000 Principal Sum (Other Acc.) PREMIUM $ 4.75
BAGGAGE AND PERSONAL EFFECTS $ 3,000 Amount of Insurance PREMIUM $ 3.75
COMBINED PREMIUM $ 8.50 Term of Coverage: 10 Days
Countersigned by ____________________________ Licensed Resident Agent
--- Please Print --- Name of Insured [REDACTED b6/b7C] Occupation [REDACTED] Address of Insured [REDACTED] City Salem State Ore. Code [blank] Name of Beneficiary [blank] Address of Beneficiary [blank] City [guess: Same] ZIP Code [blank]
Effective at: Hour 9:00 [X] a.m. [ ] p.m. Date 11-24-71 Month Day Year Place PDX Personal Signature of Insured [REDACTED] AGENT CO[cut off]
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DB Cooper-5444