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#122 UNITED STATES DEPARTMENT OF JUSTICE FEDERAL BUREAU OF INVESTIGATION File No. WasHINCTON 45, D.C. Director Federal Bureau of Investigation United States Department ef Justice Washington, D. C. Dear Sir: For inclusion in the fund to be paid to the designated be of any Special wma PS od woe MELA AG Agent,of the FBI who has previously contributed te this fund and who dies from any cause except self-destruction while employed as a Special Agent. J am forwarding herewith (by CHECK - MCMEY ORDER) the sum of §10, payable to the Assistant Director, Administrative Division, FBI, to be ineluded in said fund. Payment will be made for death by self-destruction after the Agent has heen 2 member of the fund for a continuous period of tuo years. It is underatend and agraad = Tewee Ves wer er —s that the sum tendered herewith is a voluntary, gratuitous contribution to said fund which I understand is to be administered in the following manner. The liability of the fund shall not under any circumatances exceed the agount of monies in the fund at the time any liability shall occur. The Director of the FBI will appoint a committee which shall consider all matters per- taining to the acquisition, safe keeping and expending of said fund, which committees will recom mend appropriate action to the Director in pertinent mattera. The Assistant Director of the Administrative Division of the FBI shall receive all contributions and account for same to the Director, Upon the death of any Special Agent who 1s 6 member of said fund the appointed oom mittee will consider the case and submit a recommendation to the Director as to ita conclusions. Appropriate instructions will then be issued to the Aasistant Director of the Administrative Division, directing him to pay to the designated beneficiary the sum of $10,000. The following person is designated as my beneficiary for FBI Agents! Insurance Fund: Name Estate Relaticnship Date Address The following person is designated as my beneficiary under the Chas. S. Ross Ae providing €1500 death benefit to beneficiary of agents killed in line of. duty. Ly *, “ HAME Estate Relationship 0 Dete 8 Address ’ > ae a — Very truly y yours, ay’ sa 1988 ; movi FR ee Se Q irector, “_ - sue: Cee See ce dt mle Dea at ae ie ee