RECORD OF EMERGENCY DATA
SEE INSTRUCTIONS ON REVERSE BEFORE MAKING ENTRIES
1. DESIGNATOR'S LAST NAME—FIRST NAME—MIDDLE NAME
NEWHOUSE, Delbert Clement 2. PRESENT SERVICE NO.
177283 3. RANK/RATE
CHPHOT W-4 4. DATE OF BIRTH
6/5/13 5. RELIGION
Prot.
6. HOME ADDRESS AT TIME OF ENTRY INTO SERVICE
P.O. Box 127 c/o Mrs. Vencl Richter
Garibaldi, Oregon 7. PRIOR MIL. SERVICE
YES
NO 8. FORMER SERVICE NO.
393 07 21
9. SOCIAL SECURITY NO.
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
Delbert Carroll NEWHOUSE
Anne Lisbet FORSGREN 330 Roosevelt Ave., Chula Vista
P.O. Box 63, Imperial Beach
Calif. YES X NO M F 6/28/38
3/14/40
12. FATHER
Noah Frank Newhouse ADDRESS
Tacoma, Washington
13. MOTHER
Edith May (newhouse) Richter ADDRESS
P.O. Box 127, Garibaldi, Oregon
14. ADULT NEXT OF KIN NOT NAMED IN ANY OTHER ITEM
Darrel Edwin Newhouse ADDRESS
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
None ADDRESS
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 Wife
%
18. PERSON TO RECEIVE ALLOTMENT OF PAY IF MISSING OR UNABLE TO TRANSMIT FUNDS. PERCENT OF PAY EACH MO. 100% Norma Isobel Newhouse Wife
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
Pacific Fleet Photo-Triangulation Group, at San Diego California
21. SIGNATURE OF WITNESS
C. F. REINHOZ, LTJG, USNR 22. SIGNATURE OF DESIGNATOR
DD FORM 93-1 Previous Editions are obsolete. 1 Dec 56 For Navy, Marine Corps, and Coast Guard use: Will be used in lieu of DD Form 93.