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. SERVICE
5. DATE OF BIRTH
NEWHOUSE, DELBERT CLEMENT
177 283
CWO-4
USN
6 May 13
6. HOME ADDRESS AT TIME OF LAST ENTRY INTO SERVICE (City, county, and State)
7. FORMER SERVICE NO.
3581 SOUTH EAST GRANT COURT
PORTLAND, MULTNOHAM, OREGON
393 07 21
DESIGNATIONS
FIRST NAME—MIDDLE NAME—LAST NAME
ADDRESS
RELATIONSHIP
8. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
Norma Isobel Newhouse
3581 SE Grant St.
Portland 15, Ore.
Wife
9. BENEFICIARY FOR GRATUITY PAY IN EVENT THERE IS NO SURVIVING SPOUSE OR ELIGIBLE CHILD
PRINCIPAL
Edith May Richter
P.O. Box 127
Garibaldi, Ore.
Mother
CONTINGENT
Darrel Edwin Newhouse
Rt. #6, Box 756
Tacoma, Wash.
Brother
10. BENEFICIARY FOR SERVICEMEN'S INDEMNITY (P.L. 89, 82d Congress) (All prior designations are canceled. Designation for indemnity does not affect insurance (NSLI or USGLI) beneficiary designation.)
PRINCIPAL(S)
SHARE
$
Not Applicable
SHARE
$
CONTINGENT(S)
SHARE
$
NSLI - USGLI
SHARE
11. BENEFICIARY OR BENEFICIARIES FOR UNPAID PAY AND ALLOWANCES (P.L. 147, 84th Congress)
SHARE
100 %
Norma Isobel Newhouse
3581 SE Grant Ct.
Portland 15, Ore.
Wife
SHARE
%
Delbert Carroll Newhouse
SAME
Son
12. PERSON TO RECEIVE ALLOTMENT OF PAY IF MISSING OR UNABLE TO TRANSMIT FUNDS
PERCENT OF PAY EACH MO.
Norma Isobel Newhouse
3587 SE Grant Ct.
Portland 15, Ore.
Wife
13. PERSON TO RECEIVE PERSONAL EFFECTS FOR SAFEKEEPING
Executive Officer, NATTU
COMMERCIAL INSURANCE COMPANIES 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.
California Western States L.I.C.
Sacramento, California
G. I.
Veteran's Administration
N. S. L. I.
Veteran's Administration
FIRST NAME—MIDDLE NAME—LAST NAME (If deceased, so state)
ADDRESS
15. FATHER
Noah Frank Newhouse
Tacoma, Washington
16. MOTHER
Edith May Richter
P.O. Box 127
Garibaldi, Oregon
17. WIFE OR HUSBAND (If none, so state)
Norma Isobel Newhouse
3581 South East Court
Portland 15, Oregon
18. NAME OF CHILDREN (If none, so state; If step or adopted, so state)
MARRIED
YES NO
SEX DATE OF BIRTH
Delbert Carroll Newhouse
3581 South East Grant Ct.
Portland, 15, Oregon
X M
27 JUN 38
Anne Lisbet Newhouse
SAME
X F
14 MAR 40
19. ORGANIZATION AND ADDRESS OF DESIGNATOR
20. DATE SIGNED
NATTU, Naval Air Station, Pensacola, Florida
17 May 56
21. SIGNATURE OF WITNESS
22. SIGNATURE OF DESIGNATOR
L. M. Kweel CSR USA
A. Newhouse
DD FORM 93-1
For Navy, Marine Corps, and Coast Guard use: Will be used in lieu of DD Form 93.