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( (- UNITED STATES DEPARTMENT OF JUSTICE FEDERAL BUREAU OF INVESTIGATION In Reply, Please Refer to . File No. Dotre ctor Pedersl ttuftequ ot Investigation Vaated States Tee irtment of Justice Won: ee 2 ee Liegp oar: perogr . Sa. hah tie tt to be paid ta the designated beneficiary of any Special Agent of the FHI who has Previcusly Larikoot- Got . fas, nod. dies from any cause except seii-destruction while employed as a Speciai Agent, Iam fur- wUPTE: Jo herowlt (by Check - Money Order) the sum of 820, payable to S.A.I.F 4,10 be ancluded in said fund. Payment wil} be cade for deat, yf seitedertra. thon oatter the Agent has been go member cf the fund fora continuous period of two yeors, It is wre dep et fous rareed that the num tendered herewith is a voluntary, gratuitous contribution to said fund which [ understand Sot be Gaman.. tor dan ihe on flowing manner, The Gurestor af the FFs] wall appoint a committee which shall consider all matters pertaining to the aequisiticn, safe keeping and expending of said fund, which committee will tecommend appropriate action to the Ditector an pertinent matters, The Assistant lirector of the Administrative Division of the FB] shall receive ali contributions and aecount for sane to the Dareceot., MU ypir toe deoth of any Special Agent who is gd member of said fund the appointed con mittee will conmider the case and subnat ates ro tenduticn to the Director a6 to ites conclusions, Apptoprigte ingtructions will then be issued to the Awaier Ont Tarect or ottne Administrative Divigion, directing him to fay to the designated beneficiary the sum of $26,000. The lability of the fund shai not under any circumstances exceed the amount of monies in the fund at the time any liability mhall occur. EXECUTE IN DUPLICATE AND SUBMIT BOTH COPIES TO THE BUREAU Official Bureau Nume ( (pleuse type or print) Office of Assignment for SOG Division) SA J. Edgar Hoover The following person is designated as my beneficiary for Special Agents een 0T Fund: Director Name (primary beneficiary; use given first name if female) ationship _..._Estate Relationship De you desire to designate the above-listed beneficiaries aa the beneficiary and contingent beneficiary respectively of the Char S. Ross Fumi os well? Ot, Yes ("] Ne If not, the entire following portion must be executed. The following person is designuted ae my beneficiary under the Chas. 8. Rosa Fund providing $1500 death benefit to beneficiary of agents killed in the fine of duty, ether than travel accidents. Name (primary beneficiary; use given firat name if female) Relationship Address Name | (contingent beneficiary, if desired; use given first name if female) | Relationship Addreas _ —— Very truly yours, . hig rt _ Hoover _ Dim Speqiel Agent