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ELECTION OF OPTIONS UNDER THE UNIFORMED SERVICES CONTINGENCY OPTION ACT OF 1953
NAVPER 591 (NEW 9/53)
S-3
NAME (Last)
(First)
(Middle)
SERVICE NUMBER
RANK OR RATING
USN
USNR
NEWHOUSE, Delbert Clement
177283
CHPHOT
X
PERMANENT ADDRESS
Mrs. Vencl Richter
Garibaldi, Oregon
STATUS CHECK APPROPRIATE SQUARE
NO. YEARS SERVICE COMPLETED FOR PAY PURPOSES
REGULAR
24
RESERVE
ACTIVE DUTY
INACTIVE DUTY
X
MEMBER'S BIRTHDATE
6/5/13
[X] I DO NOT DESIRE TO RECEIVE REDUCED RETIRED PAY IN ORDER TO PROVIDE AN ANNUITY FOR MY DEPENDENTS.
I ELECT THE FOLLOWING OPTIONS: (NOTE: YOU MAY SELECT OPTION 1 OR 2 OR 3 AND YOU MAY COMBINE OPTION 4 WITH THE ONE SELECTED, OR YOU MAY SELECT OPTIONS 1 AND 2 AND YOU MAY COMBINE OPTION 4 WITH EITHER OR BOTH. HOWEVER, THE COMBINED TOTAL OF OPTIONS ELECTED CANNOT EXCEED 50% OF REDUCED RETIRED PAY.)
ONLY CHECK APPROPRIATE SQUARE(S)
OPTION 1
1/8 □
1/4 □
1/2 □
OF MY REDUCED RETIRED PAY PAYABLE TO OR ON BEHALF OF MY WIDOW UNTIL HER REMARRIAGE OR DEATH.
OPTION 2
1/8 □
1/4 □
1/2 □
OF MY REDUCED RETIRED PAY PAYABLE TO OR ON BEHALF OF MY SURVIVING CHILD OR CHILDREN UNMARRIED AND UNDER 18 YEARS OF AGE AND SURVIVING CHILD OR CHILDREN UNMARRIED AND OVER 18 YEARS OF AGE INCAPABLE OF SELF SUPPORT BECAUSE OF BEING MENTALLY OR PHYSICALLY INCAPACITATED.
OPTION 3
1/8 □
1/4 □
1/2 □
OF MY REDUCED RETIRED PAY PAYABLE TO OR ON BEHALF (A) OF MY SURVIVING WIDOW UNTIL HER REMARRIAGE OR DEATH AND (B) THEREAFTER TO MY SURVIVING CHILD OR CHILDREN UNMARRIED AND UNDER 18 YEARS OF AGE AND SURVIVING CHILDREN OVER 18 YEARS OF AGE AND INCAPABLE OF SELF SUPPORT BECAUSE OF BEING MENTALLY OR PHYSICALLY INCAPACITATED.
OPTION 4
NO FURTHER DEDUCTIONS SHALL BE MADE FROM MY RETIRED PAY COMMENCING WITH THE FIRST DAY OF THE MONTH FOLLOWING THAT IN WHICH THERE IS NO BENEFICIARY ELIGIBLE TO RECEIVE AN ANNUITY UPON MY DEATH. I DESIRE THIS OPTION TO BE COMBINED WITH OPTION NUMBER(S) ______ CHECKED ABOVE.
(insert numbers)
IMPORTANT: If any of the above options is elected the following information must be furnished:
FULL NAME OF SPOUSE
DATE OF BIRTH OF SPOUSE
FULL NAME OF WIFE PRIOR TO MARRIAGE
PLACE OF MARRIAGE
(City)
(County)
(State)
DATE OF MARRIAGE
HAVE YOU BEEN PREVIOUSLY MARRIED?
□ YES
□ NO
IF YES, GIVE DATE AND CITY, COUNTY, AND STATE OF DISSOLUTION OF EACH FORMER MARRIAGE AND STATE WHETHER BY DEATH, ANNULMENT OR DIVORCE
HAS YOUR SPOUSE BEEN PREVIOUSLY MARRIED?
□ YES
□ NO
IF YES, GIVE DATE AND CITY, COUNTY, AND STATE OF DISSOLUTION OF EACH FORMER MARRIAGE AND STATE WHETHER BY DEATH, ANNULMENT OR DIVORCE
IMPORTANT: If either option 2 or 3 is included in your election, furnish required information below concerning legitimate child or children:
NAME OF EACH CHILD
DATE OF BIRTH
INDICATE IF STEPCCHILD OR ADOPTED CHILD
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