Part 45, page 27

Transcript

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

b6 per NPRC b7C

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IN THE EVENT THAT I AM NOT SURVIVED BY A SPOUSE OR ELIGIBLE CHILD, OR IF THEIR DECEASE OR DISQUALIFICATION OCCURS BEFORE PAYMENT OF SIX (6) MONTHS GRATUITY, I THEN DESIRE THAT PAYMENT BE MADE TO THE DEPENDENT RELATIVE SHOWN BELOW: 13. FIRST NAME—MIDDLE NAME—LAST NAME ADDRESS (Number, street, city, and State) RELATIONSHIP

Alan Mario List Mother

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): 14. FIRST NAME—MIDDLE NAME—LAST NAME ADDRESS (Number, street, city, and State) RELATIONSHIP

William G. List Half-Brother

15. VOLUNTARY ENTRIES I REQUEST 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 expediting action by the insurance company should a claim become payable):

FULL NAME OF COMPANY ADDRESS OF HOME OFFICE POLICY NO.

[redacted] [redacted]

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— 16. FIRST NAME—MIDDLE NAME—LAST NAME RELATIONSHIP

Helen Patricia List Wife

ADDRESS (Number, street, city, and State) RECEIVE EACH MONTH 100 % OF MY PAY. MILITARY ADDRESS SIGNATURE OF DESIGNATOR DATE SIGNED

9206th TSU TC - SFPE, Ft [guess: Mason], Calif. [signature: John C. List] 7 Jan, 52

U.S. GOVERNMENT PRINTING OFFICE : 1951 O—929241

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b6 per NPRC b7C

[largely illegible/redacted content]

DB Cooper-4650