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ES A - a iY r PRP RE sc : wea te 8 ( f UNITED STATES DEPARTMENT OF JUSTICE FEDERAL BUREAU OF INVESTIGATION In Reply, Please Refer to Meio February 4, 1972 Lite cna Feaera, rureau cf Investigation Toate: States fee, artment of tustice Secewcsed iow * A- 7a whos Le rT ie derogh the tod to be poud to the desiundwted beneficiary at any Special Agent cf the F Bl who has previcus:!, tt f podowys dies treet. amy cause except self- destruc tien while employed aa a Special Agent, | am for- » (by Cheek - Money Order) the sum cof $20, payable te L.A.I.F., tc be anciuded in agid fund, Payment will ce i cc ar a , hecli-dest ‘oon utter the Agent has been a member of the fund tora continu: us period of two years, itis 3 4 coated that othe: tun tendered herewith a8 a woluntary, gratulicus contribulion to suid fund which I understand a i tere dosh othe f aiowingy fumes. Poe loireetar af the fi! will appoint a committee which shai] consider ali matters pertaining to the acquisition, safe keeping and -«.-ading of said fund, which committee will recommend appropriate action to the Durector in pertinent matters, The Ast.stan’ Latector of the Administrative Division of the FBI shall receive alt contributions and account for same to the fare out, t#p ck: death of any Spec:al Agent who is a member of said fund the appointed committee wil consider the case and submis. a te nomenddtion tu the Directot a6 to ita conclusions. Appfoptiate instructions will then be lasued to the Agasalst- ant fire ctur atch. Administrative Division, directing him to pay to the designated beneficiary the sum of §20,000. The liability -t turd ‘'c.1 not under any circumstances exceed the amount of monies in the fund at the time any liability shali occur. EXECUTE IN DUPLICATE AND SUBMIT BOTH COPIES TO THE BUREAU OFfficrs; Vooreau Natue ‘pleas tume of npint) Date TOffics CMicia: Hureau Satie (please type or print ate itice J. Edgar Hoover Name. (primary beneficiary; us use e given firat name if female) __Clyde A. Tolson Address __ Apartment 1316, 4000 Massachusetts Ave Name (contingent beneficiary, if desired; use given firet name if female) Relationship FBI Associate NW Relationship Addreus Bo you desire to designate the above-listed beneficiaries as the beneficiary and contingent beneficiary respectively of the Chas. © Rows Fund we well? ("| Ves [Co] No Hf not, the entire following portion must be executed. The followmg person ia designated as my beneficiary under the Chas. S. Ross Fund providing $1500 death benefit to beneficiary of agents killed in the line of duty, ather than travel accidents. __..__ RE FRRXATTT iE Name (primary beneficiary; use given firat name if female) | Relationship ___ Apartment 12719, 400 Name (contingent beneficiary, if desired; use given firet name if female) Relationship Addre ba Very truly yours, ee ne Cree oe So er. en ean See ee RE A RMT OM i vai ERED SS her eo . on eee Ee