FILE NO. 177283
NEWHOUSE, Delbert Clement
(Name of officer; surname first)
Ensign, USN
(Rank and corps)
6-30-44
(Date)
REPORT OF DEPENDENTS UNDER ACT OF JUNE 10, 1922
(NOTE.—The Act of June 10, 1922, defines the term “dependent” as lawful wife, unmarried children under 21 years of age, or the [redacted] of an officer provided she is in fact dependent on him for [redacted] support.)
Number Three
Mother No
(Yes or No)
Wife Yes
(Yes or No)
Age and sex of each child under 21 years of age:
6 yrs. - male
4 yrs. - female
[redacted]
[redacted]
GPO 16-33831-1
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FILE NO. 177283
BENEFICIARY SLIP
Name NEWHOUSE, Delbert Clement
(Print name, surname to the left)
NAS, Coco Solo, C.Z. 6-30-44
(Place) (Date)
Any change since last report:
YES or NO
(Strike out one; if no change, do not fill out remainder of this report.)
Under the provisions of the Act of June 4, 1920 (41 Stat. 824), as amended by the Act of May 22, 1928 (45 Stat. 710; U. S. C. Title 34, Sec. 943), as further amended by Public Law 16, 77th Congress, approved March 17, 1941, directing the payment of six months’ pay to the widow, children, or dependent relative of any officer, enlisted man, or nurse, on the active list of the regular Navy or regular Marine Corps, or on the retired list when on active duty, or officer, aviation cadet, midshipman, nurse, warrant officer, or enlisted man of the U. S. Naval Reserve called or ordered into active naval or military service by the Federal Government for extended naval or military 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:
(Full name of wife; if not married, so state)
(Address of wife)
(Full name of child; if none, so state)
(Address of child)
(Full name of child; if none, so state)
(Address of child)
(Full name of child; if none, so state)
(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 dependent relative, my—
(Relationship)
(Name in full)
(Address)
*State briefly wherein dependency exists, such as “allotments registered,” “monthly contributions by Government check,” etc.
(OVER)
16-33831-1
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REPORT OF NEXT OF KIN
FILE NO.: 177283
NEWHOUSE, Delbert Clement
(Name of officer, surname first)
6-30-44
(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 16-33831-1