BENEFICIARY SLIP
Name Newhouse, Delbert Clement
*(Print name, surname to the left)*
Santa Elena Bay, Ecuador 2-14-43
*(Place)* *(Date)*
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Any change since last report:
YES or NO First Report
*(Strike out one; if no change, do not fill out remainder of this report)*
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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. T., 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:
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Norma Isabel Newhouse
*(Full name of wife; if not married, so state)*
1210 SE 37th Ave. Portland, Oregon
*(Address of wife)*
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Delbert Carroll Newhouse
*(Full name of child; if none, so state)*
Same as above
*(Address of child)*
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Anne Lisbet Newhouse
*(Full name of child; if none, so state)*
Same as above
*(Address of child)*
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[Redacted]
*(Full name of child; if none, so state)*
[Redacted]
*(Address of child)*
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In the event of my leaving no widow or child or of the decease before payment is made, I then designate as my beneficiary under the said act the following dependent relative, my
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*(Relationship)*
*(Name in full)*
*(Address)*
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*State briefly wherein dependency exists, such as “allotments registered,” “monthly contributions by Government check,” etc.*
(OVER) 16—22799-1
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REPORT OF NEXT OF KIN
Newhouse, Delbert Clement
*(Name of officer, surname first)*
2-14-43
*(Date)*
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Any change since last report:
YES or NO First Report
*(Strike out one; if no change, do not fill out remainder of this report)*
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Name of next of kin:
Norma Isobel Newhouse
Wife
*(Relationship)*
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Permanent residence:
Street and No. 1210 S.E. 37th Avenue
City or town Portland
State Oregon
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Emergency address:
Street and No. Same as above
City or town
State
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Delbert C. Newhouse
*(Signature)*
Photographer (Temp.), U.S.N.
*(Rank and corps)*
16—22799-1
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