Document

Produced by optical character recognition, uncorrected. These are carbon copies and mimeographs from 1941–46, so the reading is rough — treat it as a finding aid for search, not as a transcript. The scan above is the record.

AF is'cud'ss 806 . fk ) GPO 275881
=a TH = 4
» J | ELECTION OF OPTIONS pare
UNDER THE UNIFORMED SERVICES CONTINGENCY OPTION ACT OF 1953 14 Ap ST

TS ANGE FRGT NANG = HOODIE W SynviGe woMER Tanave
[Cite Alvin © o 777530 |

‘PERMANENT ADDRESS

pe Pe IEA OR ar) crm Aimee]

DATE OF RETIREMENT (it opplicobie)
5 Sep 18

T UNDERSTAND T MAY SELECT ON 1 OR 2 OR 3 AND MAY COMBINE OPTION 4 WITH THE ONE SO SELECTeD, OR THAT I MAY
SELECT OPTION 1 AND 2 AND COMBINE OPTION 4 WITH EITHER OR BOTH, AS LONG AS THE COMBINED TOTAL OF OPTIONS

BLECTED DOES NOT EXCEED FIFTY PER CENT OF THE REDUCED RETIRED PAY. WITH THE ABOVE IN MIND, I HEREBY ELECT
THE FOLLOWING OPTION OR OPTIONS:

rrr oven ~
(Cheek ove oni)

‘OF MY REDUCED RETIRED PAY, PAYABLE TO OR ON BEHALF OF MY WIDOW 80 LONG AS SHE REMAINS
Le [XDA | moana,

OPTION NUMBER 2 aad ie —
ae OF MY REDUCED RETIRED PAY, PAYABLE TO OR ON BEHALF OF MY SURVIVING CHILD OR CHILDREN, UN-
| va Laz

LD MARNIED AND UNDER Ia YEARS OF AGE.

OPTION NUMBER 9

‘OF MY REDUGED RETIRED PAY, PAYADIR 10 OW ON BEUREP (a) Or MY BURViViNG winean GRR en py
ra AARAUE Of DENTE AND 19) FABAEAPTER TO MY SURVIVING CHILD On CHILDREN, UNMARRIED AND UN.
| fa aa { Davie Means or Age. 8? ©

—! ‘OPTION NUMBER ¢ =
No FORTIER DEDUCTIONS SHALL Bb MADE FROM MY RETIRED PAY COMMENGING WITH THE FIRST DAY OF THE MONTH TOLLOWING THAT ay
[RICE THERE TS NO BENEPICIARY ELIGIBLE 10 RECEIVE AN ANHTUTTY UFON MY DEATH I DESIRE THiS OPTION TO BE COMBINED Wind OF=1ONY
DOMBER. ‘XS CHECKED ABOVE.

- DECLINATION OF OPTION —
[| RAVE STUDIED THE ABOVE, AND DO NOT DESIRE TO SELECT AN OPTION Aq THIS THE

GF ANY OF THE ABOVE OPTIONS ARE SELECTED, THE FOLLOWING INFORMATION MUST BE FURNISHED) -

NAME OF SPOUSE (Lost, First and ¥ DATE OF BIRTH (Spouse) |
MAVIS Joyce we ay Mor Jae

Fines oF mxanar iy, Coty cod at) — Saft OF MATHLAGE
Piven ARE Nasrie, Tenn Thea 43
"PREVIOUSLY MARRIED at ye re date avd place of dissolution of each former marriage and st

Whether By death, anaulinea! or
fivoree, cleo name(s) of previous spouses!)

Wi yes, give date and place of dissolution of each former marriage and state whether by death, ansuimeat or
tivoree, else name(s of previous spouses)

(CHILD OR CRLLDREN)
t ‘WAM OF EACH CHD DATE OF BIRTH.

UP EITHER OPTION 2 OR 2 IS INCLUDED IN YOUR SELECTION, FURYISH THE FOLLOWING INFORMATION CONCERNING LEGITINATE

[RELATIONSHIP (Specify if stepchild oe edopiod child) |
oF

< pmaan, aaa Pay pri RSeaR 70 HY RATE BW Re Nor mca .
Sern Den EP IN 2 PEM DE NOT MING ar 7a oe
1) RE Ea Seopa alt aay Thal ea OMe ay SN

BE Par Aiih cP ttn Best Bieri? dae Pasi BRMDORY Moss Nor COM!

SeTON £ WHT TAG OPTION SELECTED, DEE CHOSD Wet Ee ee ROM MY BETZR
Ne Te gvtione racy yyanevocaniay A ase oF MENAERS, ELECTION OF

meme On SD, Lad
he

‘SUBSCRIBED AND SWOMN TO BEYOWE Mk THis 359 |