FormMutual of Omaha scheduled airline trip insurance applications, Portland departurespage 4 of 18
formLegibility: medium

Part 18, page 122

DB Cooper-5455

Open in FBI Vault (Part 18, page 122 of the PDF)

FBI 164-81, Vault Part 18 p. 122 (DB Cooper-5455), Form, serial SE 164-81-1705 (as read from the transcript) — cooper.theunsolved.net/parts/Cooper-Part-18/pages/122

Places

AtlantaBillingsMontanaNorth DakotaOregonPortlandRochester

Transcript

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

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Application to [MUTU]AL OF OMAHA INSURANCE COMPANY [Poli]cy for scheduled airline trip insurance [num]ber [Alt]er- FIRMLY - You are making several copies [sign]ature [t of f] [Depa]rture: PORTLAND Trip to be made on: [Dest]ination: ATLANTA ☐ One-way Ticket [I and I] ☒ Round- [P]urcha[ser] trip [Insu]red's [name] [Addr]e[ss] [Bene]ficiary [Addr]e[ss] [A]t

[Cit]y PORTLAND State OR[EGON] red is owner uless checked h[ere] red's Signatu[re] V-M -[ ]

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Application to [MUTU]AL OF OMAHA I[N]SURANCE COMPANY [Poli]cy for scheduled airline trip insurance [num]ber [Alt]er- FIRMLY - You are making several copies [sign]ature [t of f] [Depa]rture: Portland, Ore Trip to be made on: [Dest]ination: [guess: Billings], Mont ☐ One-way Ticket [I and I] ☒ Round- [P]urcha[ser] trip [Insu]red's [name] b6 [Addr]e[ss] b7C [Bene]ficiary [Addr]e[ss] [A]t

[Cit]y Portland State Ore red is owner uless checked he[re] red's Signature V-M -[ ]

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Application to [MUTU]AL OF OMAHA INSURANCE COMPANY [Poli]cy for scheduled airline trip insurance [num]ber [Alt]er- FIRMLY - You are making several copies [sign]ature [t of f] [Depa]rture: PORTLAND Trip to be made on: [Dest]ination: [guess: ROCHESTER] ☐ One-way Ticket [I and I] ☒ Round- [P]urcha[ser] trip [Insu]red's [name] [Addr]e[ss] [Bene]ficiary['s] [Addr]e[ss] [A]t

[Cit]y [illegible] State [guess: ORE] red is owner uless checked here: ☑ Beneficiary is owner. red's Signature .............................. V-M -[ ] (T33AV-M - Series 30185)

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Application to [MUTU]AL OF OMAHA INSURANCE COMPANY [Poli]cy for scheduled airline trip insurance [num]ber [Alt]er- FIRMLY - You are making several copies [sign]ature of [Depa]rture: Portland, Oregon Trip to b[e] made on: [Dest]nation: [guess: Jamestown], N. Dakot[a] ☐ One-way Ticket [I and I] Round- b6 [P]urch[aser] trip b7C [Insu]red's Ticket [Addr]e[ss] [Bene]ficia[ry] [ ] [A]t

[illegible] [guess: I.gov] State Oregon ed is[ ] owner less c[h]ecked ed's Signat[ure] V-M -[ ]

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DB Cooper-5455

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b6 b7C