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- . ele cee nee Dae cote ee cae oe ee ee we eet oe ee eee et AN LECATIOU POu DEAT Nebel Ely | CIVEL SP VICE Ke rk PEE SYSTEM PMPOCP ANT. Che secuie all poosttile 1 wales cud to oO aon A! Ww lay: i. Kead ¢ carefully ‘the “bifGrmation for whe Applicant” on ce Peewee Of sheets 2. Cosng fae application io full; &. Tb answer qo any question is “eo? ot “none” su sete; 4. Type or . prt i tik, ’ AL PLESGE! AL Wt ORK AAUOK | ¢ ONCERING G THE DECCASZD i - eee me cod a ae ane gl a dP ard ln a -. sR TRU Maret OF IME de ae this thas i {feot) UMahdh 2 DALE OF EIRIH 3. DATE OF DEATH AE ; vA foe" (Veur) (Mpnth} (Day) (Vear} oe Hoover, Joba h AA 5/2/1972 : : wy Prarie © ee ee co "Fy How wee pALPLiAGe 3h TLE 7 Dale sAbeiaGe WAS 4 DOME Chetan GG ott dae 6 GIVE Hoel OF EACH SPOUSE fimdink aff format 7. HOW WAS AAERIAGE TLR 1 3. DATE MARRIAGE WAS efi tay and Non, wnat hipaa} MINATED? €Chiak ore fx TERMINATED oe each peas Washington, D.C, to peatn [7] divorce SHOW Pactra WAS DUCTAMLD PE ee wera ee | [CD oem Ly pworce none {] peat [] ovorce SE eee ee md oe ee ce ee ee mE eee ae BL INFORMATION CONCERNING CI CIVILIAN Ab AND (D> PAN TTARY SERVICE OF” THE C “DECEASED 1, DEFAGTATAT OR AGLI. TM WiihCH LAST HAPLOYED, INCLUDING BLUE AU 2D location OF 1453 EMPLOY NT = DATE Of FINAL SEPARATION elo/T oes (Year) of OF LalviSioiN (City and State) Wee te weet Desseei ay nt Trernetiggt inn Washi waertn neo PEeaACVAL PUP OL ANVES LIP ALLO RASULNEVOT , etre ro VAS by ct ASTD RRee “END RL TSF RULED, @P oly rE CLAIM NUPBER, ~ 6. DD DECEAS! D HAVE & SOCIAL 7. WF ANSWER TO ITEM 6 iS YES" CRIVING CiVi SERVICE Alatiuiry? ENOWH SECURITY TUMBLER? GIVE DECFASED'S SOCIAL SECU- RITY ACCOUNT NUMER Klves [] no 577-60=1114 BUF DECEASED HAD RERUTRED ACTIVE DULY, WHICH TEMAINATED UNDTR HONORAELE CONDIMNIG NS, ld ANY OF THE FOLLOWING SERVICES, COMPLCTE THE SCHEDIKE BELO, TO THE BEST OF YOUR ALITY IF AVASLALLE, ATTACH A COPY OF THi DISCHARGE CERTIFICATE. fo) ARMY, NAVI, MALICS CORPS, AIR FORCE, OR COAST GUARD OF THE UNITED STATES, OR * FL) BR. CULAR CORPS OX RESERVE CORTS GF THIL FUPIIC HEALTH SERVICE AFTER RINE 30, 19460; OR fe} AS a CAAT SIGL LD OFFICER CF THe COAST AND? GECDENIC SURVEY AFTER JUME 30, F925, GR fd) AL A COMMISSIO IE ORUICER IN THL ERIVIROACLMTAL SCIENCE SERVICES ADMMINISTRATICH. : BRARICH OG. SEANICE SERIAL NG. CSa- “prle OF enixerice | DATE OF SEPARATION | LAS! GkADE “ORGANIZATION AT DISCHAKSE ON ACUIVE DUTY FROM ACTIVE DUTY OR RANK (Dic., Megivsut, Co, tte} eee. vee pees seer een. Cc INI-O ORIAA TON CONCERNING. Tt APPLICANT _ 1. TOUR AME (Last) (flint) ¢Msddhey, } 2. YOUP. RELATIONSHIP 3. YOUR DATE OF we MR TO THE DECEASED t war . t xX . 7 r AF} xix Tolson, Glyde A. Executor ESTOS : « ARL YOU A CHLEM G. GGL UNITED STATES Cf AWERICAP 3. ANSWER YO TEfa 4 1S “NO,” OF WHAT COUNTRY ARE YOU A CITIZEN? (Phere ON an fr fos baa) fx] vEs f] ND Fill iu ttems 6 “pro all th 16 Af you ave the uidaww or ata of the deceised, “6 Lalit GP ae SFI GE ~ ? “PACE OF MARKIAGE fe wy iy wud 8. MARRIAGE WAS FERFOR ALD BY CLERGYMAN OR JUSTICE OF C(Meowh; fthoaj}o eer) State) 9. WERE YOU LIVU;G WITH DECEASED AT TIME OF DEATH? THE PEACE [-] orner (Spevify) 10. WERE You! EVE 12 GEV NAME OF EACH SPOUSE ffocdude all former | 13. HOW WAS MATRIAGE IER. | 14. DATE MARRIAGE . DO-YOU HAVE A DIVORCED FROM Marr ettas ) MINAIED? (Chick one fn WAS TERMINATED SOCIAL SEO ARE? DECEASED? ee ee ee Sc 2 COUNT NUMB' [Jus [J] x0 (J oan 0 ow DIVORCE ane jes we me ee - HEM 15 5° MAHAN THAL . GIVE TOUR HUMES WIRE YOU MARRIED? oO DEaqn C]' BIVOKCE Haas | 1, 7.18, and 19, of tly outy ef you are thu tdor ot Chusbund) of te deecascd odd. 17. APL YOU ItvCa® PLP OF SHLF- [Ve bin vOU RECEIVE SORT Than “Te YOUN ANSWEPS 10 BOTH TILMS 17 ANO 18 ARE “YES.” AND 0 THE SUFFORT BECAUSE OF DIS OME HALE YOUR SUPPORT FROM DECEASED THED WILE STIL EMPLOYED AFTER AT LEAST 16 MONTHS CIVILIAN ABI? THE DECREASED? BLRKVICE, ATTACH A SEPARATE SHIET GIVING FULL PARTICULAFS ABOUT YOUR DIT ABILITY ANG THE EXTEAtE OF SUPPORT FROM THE DECEASED AND A SUMALARY [_] ves 0 NO LJ ves [_] no OF TOUR INCOME FROAA ALL SOURCES ee ee de a et - ~ IEOK MAATION CONCH aE 1G 3 THEE ESTATE OF Tit THE DECEASED” ee a ini cude fot ey aga EXECUTOR OF rGoumdiciza. hey AAP > fig frrtre ECE ALL OWNED B¥ Tt COwkT 10> StH THE ESTA: OF Tt 2 of AN EXEC mR ADS A, ; Oe stv, Hyg. ae se 3 OF ns EXICLITGR Ch ADMIRISTEATC?. : _. _ _ _ TOR HAS NOT BEEN APPOINTED, j Nant wonss Cfo Kiges National Bank WILL ONE BE APPOINTED? Ciyds A. Tolsen Personal Trust divi $i ign P.O. Box 1490 "s [jr e pues . _[Weshington, 0. D.C peterpan eer weer : “ ; (CONTINUE ON OTHER SIDE) “STANDARD FORM 4800 al ee ME ET eg me PORE MTS ewe) OR AT Sree remem farce yA crmerfapcempes LIST. mast , ‘.