FormMutual of Omaha scheduled airline trip insurance applications, Portland departurespage 15 of 18
formLegibility: medium

Part 18, page 133

DB Cooper-5466

Open in FBI Vault (Part 18, page 133 of the PDF)

FBI 164-81, Vault Part 18 p. 133 (DB Cooper-5466), Form, serial SE 164-81-1705 (as read from the transcript) — cooper.theunsolved.net/parts/Cooper-Part-18/pages/133

Transcript

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

INSERT THIS END FORWARD

Application to JAL OF OMAHA INSURANCE COMPANY for scheduled airline trip insurance

FIRMLY - You are making several copies

Departure: Portland, Oregon Trip to be made on: [illegible] ☐ One-way Ticket ☒ [guess: One-way Ticket checked] Destination: Los Angeles, Calif ☐ Round-trip

Purchaser's name, address: red's [illegible] e [illegible] official [illegible] e [illegible]

...y [guess: Compton]... State Califor[nia] red is owner unless checked here: ☐ Beneficiary is owner red's Signature V-M

---

INSERT THIS END FORWARD

Application to JAL OF OMAHA INSURANCE COMPANY for scheduled airline trip insurance

FIRMLY - You are making several copies

Departure: [guess: Portland], Ore Trip to be made on: [illegible] ☐ One-way Ticket Destination: [guess: Salt Lake], [illegible] ☐ Round-trip

Purchaser's name, address: red's [illegible] [illegible] official [illegible]

et .et [illegible]

...y [illegible]... State [guess: Calif] red is owner unless checked here: ☐ Beneficiary is owner red's Signature V-M

---

INSERT THIS END FORWARD

Application to JAL OF OMAHA INSURANCE COMPANY for scheduled airline trip insurance

FIRMLY - You are making several copies

Departure: PORTLAND, ORE. Trip to be made on: [illegible] ☐ One-way Ticket Destination: LOS ANGELES ☒ Round-trip

Purchaser's name, address: red's s[illegible] ie [illegible] oficiary [illegible] ie [illegible]

...y OREGON.S.ITY... State OREGON red is owner unless checked here [illegible] red's Signature V-M

---

INSERT THIS END FORWARD

Application to JAL OF OMAHA INSURANCE COMPANY for scheduled airline trip insurance

FIRMLY - You are making several copies

Departure: Part. Land, ORe Trip to be made on: [illegible] ☐ One-way Ticket Destination: Lo.S.. Angeles, Calif ☒ Round-trip

Purchaser's name, address: red's [illegible] e [illegible] officiary [illegible] e [illegible]

...y D.R.E.G.O.N. S.I.T.Y... State [illegible] red is owner unless checked here [illegible] red's Signature V-M

---

b6 b7C

DB Cooper-5466