FILE No. 177283
NEWHOUSE, Delbert Clement (Name of officer ; surname first)
Ensign, USN (Rank and corps)
19 August 1944 (Date)
If your status has changed from "no dependents" to "dependents" (or vice versa) since last report, indicate by $ \surd $ in this space $ \square $
REPORT OF DEPENDENTS UNDER ACT OF JUNE 10,1922
OTE.—The Act of June 10, 1922, defines the term "dependent" as a lawful wife, unmarried children under 21 years of age, or the mother of an officer provided she is in fact dependent on him for her chief support.
Yes
(Yes or No)
Yes
Wife
(Yes or No)
Age and sex of each child under 21 years of age: Male - 6 yrs.
Female - 4 yrs.
BENEFICIARY SLIP
Name NEWHOUSE, Delbert Clement (Name in full, surname to the left)
Serial No. 177283
(File number, not signal number)
Ship or station NAS
COCO SOLO C Z
(Name)
Under the provisions of the Act approved May 22, 1928, as extended by the Act of March 17, 1941, directing the payment of 6 months' pay to the widow, children, or dependent relative of any of the personnel on the active list of the Regular Navy, or on the retired list when on active duty, or of any of the personnel of the Naval Reserve called or ordered into active naval service by the Federal Government for extended naval service in excess of 30 days, who dies of wounds or disease not the result of his or her own misconduct. I give below the name and address of my wife and that of each of my children:
(See instructions on reverse side)
NO CHANGE SINCE LAST REPORT
(Full name of wife; if not married, so state)
(Address of wife)
(Full name of child; if none, so/state)
(Date of birth)
(Address of child)
(Full name of child)
(Date of birth)
(Address of child)
(Full name of child) (Date of birth)
(Address of child)
In the event of my leaving no widow or child or of their decease before payment is made, I then designate as my beneficiary under the said Act the following relative, my
(Relationship)
(Name in full)
(Address)
*If the beneficiary named above is your father, mother, brother, or sister, you need not fill in these three lines. If the beneficiary is a more distant relative, such as a grandparent, state briefly wherein dependency exists, such as "allotments registered," "monthly contributions by Government check," indicating amounts and regularity thereof.
[OVER]
177283
File No. ___
REPORT OF NEXT OF KIN
NEWHOUSE, Delbert Clement (Name of officer, surname first)
19 August 1944
(Date)
Any change since last report:
YES or NO
(Strike out one; if no change, do not fill out remainder of this report.)
Name of next of kin ___
(Relationship)
Permanent residence:
Street and No. ...
City or town ...
State___
Emergency address:
Street and No. ...
City or town ...
State___
(Signature)
(Rank and corps)
GPO 16-33831-2