Part 36, page 49

Transcript

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

RECORD OF EMERGENCY DATA FOR THE ARMED FORCE THE UNITED STATES INFORMATION INCLUDED THIS FORM DOES NOT DESIGNATE OR CHANGE BENEFICIARIES OF LIFE INSURANCE POLICIES (See instructions on reverse side of form prior to making entries)

3. DESIGNATOR'S LAST NAME-FIRST NAME-MIDDLE NAME: Booton, John Don 2. SERVICE NO.: RA17 292 092 3. GRADE, RANK OR RATE: Rct 4. SERVICE: [X] USA [ ] USN [ ] USAF [ ] USMC [ ] USCG

5. FIRST NAME-MIDDLE NAME-LAST NAME OF PERSON TO BE NOTIFIED IN CASE OF EMERGENCY (Person with permanent address is advisable): Ruth Schneider RELATIONSHIP (If friend, so state): Mother ADDRESS (Number, Street, City and State): 905 W. Prairie St., Marion, Ill.

THE PERSONS NAMED IN ITEMS 6, 8, AND 9, BELOW WILL ALSO BE NOTIFIED OF THE EMERGENCY. IF SUCH NOTIFICATION IS NOT DESIRABLE, DUE TO HEALTH OR FOR OTHER PERTINENT REASONS, PLEASE SO STATE UNDER "REMARKS" ON THE REVERSE SIDE.

6. SPOUSE (First name, Middle Name, Last name) (If none, or if deceased or divorced, so state): None

7. CHILDREN FIRST NAME-MIDDLE NAME-LAST NAME | ADDRESS (Number, Street, City and State) | MARRIED OR SINGLE | SEX | AGE

None

CAUTION: SPECIAL [stamp] This [illegible] [illegible stamp text overlapping - appears to reference original forms and continuing entries]

8. NAME OF FATHER (or male guardian) (First name, Middle name, Last name): Ray Booton ADDRESS (Number, Street, City and State): 905 W. Prairie St., Marion, Ill.

9. NAME OF MOTHER (or female guardian) (First name, Middle name, Last name): Clara Leora Booton ADDRESS (Number, Street, City and State): 905 W. Prairie St., Marion, Ill.

IN THE EVENT THAT I AM NOT SURVIVED BY A SPOUSE OR ELIGIBLE CHILD, OR IF THEIR DECEASE OR DISQUALIFICATION BE- FORE PAYMENT OF 6 MONTHS GRATUITY IS MADE, I THEN DESIRE THAT PAYMENT BE MADE TO THE DEPENDENT RELATIVE SHOWN BELOW. (See Instruction 4 on reverse side of form)

10. FIRST NAME-MIDDLE NAME-LAST NAME: Clara Leora Booton RELATIONSHIP: Adopted Mother ADDRESS (Number, Street, City and State): 905 W. Prairie St., Marion, Ill.

IN THE EVENT OF DEATH OR DISQUALIFICATION OF THE ABOVE NAMED DEPENDENT RELATIVE, I THEN DESIGNATE THE ALTERNATE DEPENDENT RELATIVE SHOWN BELOW. (Other than spouse or child)

11. FIRST NAME-MIDDLE NAME-LAST NAME: Ray Booton RELATIONSHIP: Adopted Parent ADDRESS (Number, Street, City and State): 905 W. Prairie St., Marion, Ill.

VOLUNTARY ENTRIES I REQUEST THAT THE FOLLOWING COMMERCIAL LIFE INSURANCE COMPANIES BE OFFICIALLY NOTIFIED IN CASE OF MY DEATH IN ACTIVE SERVICE. (The "Policy Number" should be entered if possible, since this information will assist in expe- diting action by the insurance company should a claim become payable.)

12. FULL NAME OF COMPANY | ADDRESS OF HOME OFFICE | POLICY NO. None (Continue on reverse side)

IN THE EVENT THAT I AM LISTED AS MISSING, OR BY OTHER MILITARY CIRCUMSTANCE AM UNABLE TO TRANSMIT FUNDS TO MY DEPENDENTS, IT IS MY DESIRE THAT

13. FIRST NAME-MIDDLE NAME-LAST NAME: None RELATIONSHIP: ADDRESS (Number, Street, City and State): RECEIVE EACH MONTH $ OF MY PAY.

MILITARY ADDRESS: 6th Armored Division, Fort Leonard Wood, Mo DATE SIGNED: 16 Oct 50 SIGNATURE OF DESIGNATOR: [signed] John Don [guess: Booton]

DB Cooper-10277

DD FORM 93 1 JUL 50 REPLACES DD FORM 93, 1 JAN 50; NME FORM 93 1 OCT 48; NAVMC 12[0]/135 PDI; NAVPERS 692, PAGES 7 AND 8; AND NCG 2529, WHICH MAY BE USED UNTIL 1 JANUARY 1951, WHEN THEY WILL ALL BECOME OBSOLETE.