RECORD OF EMERGENCY DATA
SEE INSTRUCTIONS ON REVERSE BEFORE MAKING ENTRIES
1. DESIGNATOR'S LAST NAME—FIRST NAME—MIDDLE NAME
2. PRESENT SERVICE NO.
3. RANK/RATE
4. DATE OF BIRTH
5. RELIGION
NEWHOUSE, Delbert Clement
177283
CHPHOT W-4
6/5/13
Prot.
6. HOME ADDRESS AT TIME OF ENTRY INTO SERVICE
7. PRIOR MIL. SERVICE
8. FORMER SERVICE NO.
9. SOCIAL SECURITY NO.
P.O. Box 127 c/o Mrs. Venc1 Richter
Garibaldi, Oregon
☐ Yes ☐ No
(DATE LAST ENTRY)
393 07 21
540-46-3224
FIRST NAME—MIDDLE NAME—LAST NAME (If deceased, so state)
ADDRESS
10. WIFE OR HUSBAND (If none, so state)
Norma Isobel NEWHOUSE
652 Burnham St., El Cajon, California
11. NAME OF CHILDREN (If none, so state. If step or adopted, so state)
ADDRESS
MARRIED
SEX
DATE OF BIRTH
YES
NO
Delbert Carroll NEWHOUSE
330 Roosevelt Ave., Chula Vista.
X
M
6/28/38
Anne Lisbet FORSGREN
P.O. Box 63, Imperial Beach Calif.
X
F
3/14/40
12. FATHER
ADDRESS
Noah Frank Newhouse
Tacoma, Washington
13. MOTHER
ADDRESS
Edith May (newhouse) Richter
P.O. Box 127, Garibaldi, Oregon
14. ADULT NEXT OF KIN NOT NAMED IN ANY OTHER ITEM
ADDRESS
Darrel Edwin Newhouse
304 Labor Temple, Tacoma 3, Washington
14a. ALL PERSONS RECEIVING MORE THAN 50 PERCENT OF THEIR SUPPORT FROM ME (OTHER THAN WIFE OR CHILDREN UNDER 21)
ADDRESS
RELATIONSHIP
DATE OF BIRTH
Florence Estelle Strom
4619 N. Michigan Avenue
Portland, Oregon
Mother - in-Law
5/4/81
15. PERSON(S) NAMED ABOVE WHO ARE NOT TO BE NOTIFIED DUE TO ILL HEALTH
ADDRESS
None
DESIGNATIONS
16. BENEFICIARY FOR GRATUITY PAY IN EVENT THERE IS NO SURVIVING SPOUSE OR ELIGIBLE CHILD(REN). NAME PARENTS OR BROTHERS OR SISTERS ONLY (P. L. 881 84th Congress).
FIRST NAME—MIDDLE NAME—LAST NAME
ADDRESS
RELATIONSHIP
Edith May Richter
P.O. Box 127
Garibaldi, Oregon
Mother
Darrel Edwin Newhouse
304 Labor Temple
Tacoma 3, Washington
Brother
Noah Frank Newhouse
Tacoma, Washington
Father
17. BENEFICIARY OR BENEFICIARIES FOR UNPAID PAY AND ALLOWANCES (P. L. 147, 84th Congress). PERCENT OF SHARES MUST TOTAL 100 PERCENT.
100% %
Norma Isobel Newhouse
652 Burnham St.,
El Cajon, California
Wife
%
18. PERSON TO RECEIVE ALLOTMENT OF PAY IF MISSING OR UNABLE TO TRANSMIT FUNDS.
PERCENT OF PAY EACH MO.
Norma Isobel Newhouse
652 Burnham St.,
El Cajon, California
Wife
100%
19. INSURANCE POLICIES IN FORCE INCLUDING USGLI AND NSLI (Agencies to be notified in case of death in active service)
FULL NAME AND ADDRESS OF COMPANY
ADDRESS OF OFFICE RECEIVING PAYMENT OR HOME OFFICE
POLICY NO.
National Service Life Insurance
Government Life Insurance
Veterans' Administration,
Munitions Building, Washington 25, D.C.
V774432
K948857
20. SERVICE ORGANIZATION AND ADDRESS OF DESIGNATOR
DATE SIGNED
Pacific Fleet Photo-Triangulation Group, at San Diego California
24 August 1959
21. SIGNATURE OF WITNESS
22. SIGNATURE OF DESIGNATOR
C. F. REINHOLZ, LTJG, USNR
Delbert C. Newhouse
DD FORM 93-1 1 Dec 56
Previous Editions are obsolete.
For Navy, Marine Corps, and Coast Guard use: Will be used in lieu of DD Form 93.