Final Personnel Record for Newhouse Delbert C US Navy 1957
⚠ Texto extraído por OCR de la fuente oficial — puede contener errores de reconocimiento. El documento original es la autoridad.
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NAVPERS - 774 (NEW 11 / 55)
.' __ ..,
, RECORD OF EMERGENCY DATA --....;.1 I
SEE INSTRUCTIONS ON REVERSE BEFORE MAKING ENTRIES
4. SERVICE 5. DATE OF BIRTH
1. DESIGNATOR'S LAST NAME-FIRST NAME-MIDDLE NAME Z. PRESENT SERVICE NO.
NEWHOUSE. Delbert Clement 177283 1··;;_: 1 USN 5/6/13
6. HOME ADDRESS AT TIME OF LAST ENTRY INTO SERVICE (CUr,, countr,, and State) 7. FORMER SERVICE NO.
c/o Mrs. Vencl Richter
Garibaldi, Oregon 393 07 21
DESIGNATIONS
. FIRST NAME-MIDDLE NAME-LAST NAME ADDRESS
~u~ jjryant rtoaa
8, PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
Norma Isobel. NEWHOUSE N.P.,Pensacola,Fla. Wife
P • u. tlox u.·1
9, BENEFICIARY FOR GRATUITY PAY
PRINCIPAL
Fn.ith May Richter Garibaldi, Oregon Mother
IN EVENT THERE IS NO SURVIVING
SPOUSE OR ELIGIBLE CHILD Rt ffo, Box ff'/56,
CONTINGENT
Darrel Edwin lfewhouse Tacoma, Washington Brother
SHARE
10. BENEFICIARY FOR PRIN, s Not Applicable
SERVICEMEN'S INDEM- CIPAL(S) SHARE
NITY( PLt3,Bld Con-
ureaa) ( All prior dea· s
ignationa are canceled.
Deaignation for in- SHARE
demnUr, dou not afect
in,urttnce ( NSL or
USGLIJ bcnejidart1 CONTIN•
s NSLI - USGLI
designation) GENT(S) SHARE
s
SHARE
11. BENEFICIARY OR BENEFICIARIES
FOR UNPAID PAY AND ALLOWANCES
100 % Norma Isobel Newhouse Same as #8 Wife
( PL 147, 8.ftA Congreaa) SHARE
% Delbert Carroll Newhou~e ditto Son
12. PERSON-TO RECEIVE ALLOTMENT PERCENT OF
OF PAY IF MISSING OR UNABLE TO PAY EACH MO.
TRANSMIT FUNDS Norma Isobel Newhouse ditto Wife
13. PERSON TO RECEIVE PERSONAL·EFFECTS FOR
SAFEKEEPING
Executive Officer. NATTU
D IN CASE OF DEATH IN ACTIVE SERVICE
FICE RECEIVING PAYMENT OR HOME OFFICE POLICY N .
G. I. Veteran's Administration
N. s. L. I. ditto
FIRST NAME MIDDLE NAME-
15. FATHER
Noah Frank Newhouse Tacoma, Washington
16. MOTHER P. o. Box .12·1
Edith May Richter Garibaldi, Oregon
17. WIFE OR HUSBAND ( 1/ none, ao ,tate)
Norma Isobel Newhouse Same as #8
18. NAME OF CHILDREN ( 1/ none, ,o ,tate. If atep or adopted, ,o atate) ADDRESS SEX DATE OF BIRTH
Delbert C~rroll Newhouse Same as #8 X M 6/27/38
Anne Lisbet Newhouse ditto X F 3/14/40
19. ORGANIZATION AND ADDRESS OF DESIGNATOR 20, DATE SIGNED
NATIDHrRAU. NAS. Pensacola. Florida 2 May 1957
21. SIGNATURE OF WITNESS
7/l r.AA~uc_,•
- "'MJ
a ~.J~'
22.~SIGNA
DESIGNATOR
T U R•E .
-
OF
--- ---- ..... ~
For Navy. Marino Corps, and Coast Guard use: Wlll be used In Ueu of D.D Form 93.
....
• Pers-'824-CBE:jlk
177283
15 '-.y 1957
Fran: Chief of naval Personnel
To: • , CHPHOl' \:l- 4 Delbert c. UEWHOOSE, USN
Via: 1
Cor:.manding Officer
NaVl:.l Ur Technical Training Unit
u. S., Na.val Air Station
Pe.'1.aacola, Florida
Subj : . Hom/} o! Record; change ot
Ro!': (a) Your ltr of 2 Hay 1957 tdth' 1st end.
1. In rcp}i to reference (a), the records of the &lreau have been
changed -to eh0\1 your h001e of record to be Pensacola, Florida, et1'ective
this date.
V• ::• ARMSTRam
By direction
( .
,. ::-
t! AIR TECHNICAL TRAIN!Nt!T
U. S. NAVAL AIR STATION
)
PENSACOLA, FLORIDA IN REPLY REFER TO
1 -...J..'l.'ZW/8311/(mag)t
2 May 1957
From: cwo De-U,~ .clem§lnt . NEWHOUSE, USN
To : Chief of Naval Personnel
Via: Commanding Offi cer
R:t;c
Subj: Change of home of record; notification of
Ref: (a) Article B- 2206, BuPers Manual MAYG7 1957
1. This change of addr ess is submitted as authorized in paragraph (2)
of reference (a) .
2. My home of r ecord is changed as follows:
Fr om: c/o Mrs. Vincl Ric hter
Garibaldi, Oregon
To: 208 Bryant Road, Navy Point
Pensacola, Florida
3. It is requested that the records of the Bureau be
~ -NEWHOUSE
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - NC/Pncla/( mag)
Pl
FIRST ENDORSEMENI' 2- MAY 1957
From: Commandi ng Officer
To: Chief of Naval Personnel
1. Forwarded.
F . M. HALL
By direction
C-1
NO/Pncla/(mag)
Pl5
177283/8311
12 DEC 1956
FIRST ENOORSEMENI' on BuPers ltr Pers F24-Ifbmjs of 10 D'eo 1956
From: Commanding Officer, Naval Air Technical Training Unit, Navo.l Air
Station, Pensacola, Florida
To: GHPHCll', vl-4 Delbert O. NEWHOUSE, USN
Subj: Awards; information concerning
l. Delivered.
EDWIN L. KilM
Copy to:
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DA:rA SHEET TO ACCOMPANY CLAI~OR -
REI. .SEMENT FOR DEPENDENTS' ~VEL
(All entries to be made by the claimant in his own handwriting)
ents ;he following data is sub j ; d ;; ubs ~i~ ; f my c l a i ~ ~
reimbursement
f o r for travel performed by my depend-
MEMBER'S FULL NAME / ~ ---~ - ! ______ ______________/ _Zz~_'F'__J______r;:__~__t?__--:_t_
(First) (Middle) 7 (Last) (Service number) (Ranlc/rate)
ADDRESS TO WHICH CHECK IS TO BE MAILED: ---------------------------------------------------------------------------------------
WIFE'S NAME: - - ~---- J ~----~-----------------------------------------------
*CHILDREN'S NAMES: RELATIONSHIP DATE OF BIRTH
___/ ~ ~ ---~ - ---~---------------------¼-~,!_?:_ ____
______Q / 1 - v 1 ' 1 L - ~ - - ~----£ k . . ~__________3 / 4 ~ Q______ _
------------------------------------------------------------------------------------·----------------·--------------------------------------·------------------------------
*Step children or adopted children must be classified as s uch. Dependent parent must be classified and claimed as such.
"I certify that my dependents were located at (Street address, city, and State)-3:[_fL___ JE__~ - ~
R ~--/- --(!)/J.L~------------------ wh~ ocdm <licecting d,taohm,nt from my old p•rman~t station
were received and departed that place on (Date) __ 2/1_u~__f ______________ ; and arrived at (Street address, city, and
State) 2 J ~ _ ~ _ f _ J _ _ T j __ - _" ----- -J---e f ~ - - - ----, on (Date) G________ ; _3-/4/6-___
that such travel was performed at my own expense, nd that the travel covered by this claim represents the entire travel
of all my dependents which has been or will be made on this change of station except as follows: (Exception, if any)
------------------------------------------------------------------------------------------------------------------------------------------------------------------------
If orders direct my travel overseas where dependents are not permitted to go, I HEREBY DESIGNATE (Street ad-
dress, city, and State) ----··-------··-----------··-------------------------------------------------------------------------------------------------------
as point to which transportation of dependents is desired.
I certify that my dependents were last transported or reimbursed at Government expense for travel to _____________________
_______________( P e n ~ / @ ~ --------------------------------- -------- ----- ------------------ ---"
NOTE.-This data sh eet is to be presented to the disbursing officer with the original and three certified copies of travel
orders, with all endorsements. The "Voucher for Reimbursement for Expenses Incident to Dependent T ravel"
(NAV. S. AND A. FORM 912 Rev.) will be signed when completely filled in. This "Data Sheet" or the "Voucher
for Reimbursement for Expenses Incident to Dependents Travel" (NAV. S. AND A. FORM 912 Rev.) will not be
signed in blank.
" I further certify that all entries made above are in my own handwriting and are true and correct; that I have
read this completed data sheet and understand that any misrepresentation or concealment of material fact by me
may work a forfeiture of the claim and subject me to trial by court martial or Federal District court and to penal
ties extending to 5 years imprisonment or $10,000 fine, or bot h."
p:¾........,,,___c
NAV. S. AND A. FORM 915 (4-53)
U. S, GOVERNMENT PRINTING OFflCE l G-68710-1
RECORD OF EMERGENCY DATA
SEE INSTRUCTIONS ON REVERSE BEFORE MAKING ENTRIES
• •
6. HOME AOO~ESS AT TIME OF LAST ENTRY INTO SERVICE (Citv, countr,, and State) 7. FORMER SERVICE NO.
3581 SOUTH EAST GRANT COURT
PORTLAND, MULTNOHAM, OREGON
'393 07 21
DESIGNATIONS l ) I'
FIRST NAME-MIDDLE NAME-LAST NA~E ADDRESS RELATIONSHIP
8. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
3581 SE Grant Gt.
Norma Isobel Newhouse Portland 15. Ore. Wife
PRINCIPAL
P.O. Box 127
9. BENEFICIARY FOR GRATUITY PAY
IN EVENT THERE IS NO SURVIVING
Edith Mav Ri·chter Garibaldi. Ore. Mother
SPOUSE OR ELIGIBLE CHILD
CONTINGENT
Rt. #6, Box 756
Darrel Edwin Newhouse Tacoma. Wash. Brother
SHARE
10. BENEFICIARY FOR
SERVICEMEN"S INDEM
PRIN
CIPAL(S)
Not Aoolicable
SHARE
NITY ( PL es,
Btd Con-
0TtS8) ( All prior dts·
ignationa are canceled.
Designation for in- SHARE
' de ,nnitr, does not affect
. inaitrance (NSLI or
USGLI) benejiciarr,
5 -NSLI·· ..,. ·USGLI
CONTIN- 1-------+=-===--..-==:;..:::.:::;:=.----....,...----,----1-------------,--+---------1
·· · · --
;designation). : ,1. i G~~:r(s), SHARE (•t ,i, •,•.•:::.:·,J.,••-'. :;1,v ·•:•;,: :.:.· [-U·/?..l ;, ."E!l - :~ • 1 .. :.-,:;_,,Jl''i :::::• r,, ,_
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14. • • • '. •••• • ,. ·COMMERCIAL INSURANCE COMPANIES TO BE NOTIFIED lN CASE OF;DEATJ:f!JN 1ACiflVE 'SE~ViQE • -··· "( '-- 1 !.t:. .•,;_ i:1i~.,nfl••T
15..FATHER' :,, •.. ' :.'. ,, • ''-:-;- l.J.'"'; ·; ':•<:•·•.· ~J.·::; ~'I ~ . .,1, {:•.fll;)J\j(,&;J~-. ..,,..•...l 1 . ~i!••;.1:, f • 1~\•;,•
;1. •··•-a_1i'.1<·_;;--;· 1,L ( ,'~1ii'r; .• • f
'·Noah i~ahk' N~\~h~{i;~e''.>L!.i~);~.r:.:l.:;:;_:}/;1,'.·i·\,f,
~J:r.Js·· +,· , _,,i,. J.;.:l.•'H} -r:·1· ;;_::;;
1 1
,'.: Tacoma,: 1Washin~on ;i'': .•<•. -·~· • • , . , : . ;,, -. •1 !'(
16, MOTHER: ,,,·;::! •. :: '.·.I '"'''"''•'; :,,,i.:; j•'• ,,,.I,,_·,.: ., f.Jl'
• ·,·• 1.:;~:·· 1 <,. 1 :· .;if, '-,.·1,!'f -~·~·.: ~f! .. 1, ·i .~7/.!;,1,q •.•. q I
1
l~~J,"'.L.
Edi·th,-:Mavj• Richte,r '!''·!,!.'. {') Ji;c,,i",, ;-pr,•: 'lli),'if;:.-:,
17. WIFE OR HUSBAND ( 1/nbnt; .roitiilei ': •. I 1.1.;,,'.· '.:!)'; J.••i :~ 1 II,:,· ,' • 1•
: rt,t1; t (j,.,; ,-.1 ,,.
:Norina·· Isobel'.; Ne,whouse ;.;1, ..... : j ·,. n,,. ;,ir1.r!r.n:~1,
,/1.l~!l!. :.t.~1;~,.i~1,• ~~_. ff;;.'. ,·,:.j: '~J / , 1nJ. tit;::rr· r:- n,_,,;r.;..,:,:;~; ',' \~U~i- °7_:!,r:1:.:~?. h\f.JC!jJ ·f.1,;{! •p.;.-::if~ ~-\ t.L(.~-~'•' {M-ARR1£[).lJ:f~q f ;r,. ~'_.;;c; :r1~:\,;_
1
18> •(:NAME OF ~HILDREN,('if,none, aostpte;, ~ .!J3tep,or ad-Opted,,,i, st!l~)d liJ"c: ! : !; : '1_ \ \f \\\ \ ~DDR~S l ~-L !J~nlJ .. ·, • .i•; '2!] •JI.F; ., r, ;_ • ;·· ; , SE'Xl: (,('.Dl\:tE 0FlBIR1lt 0
•• ~:-: f,., ·,- if I,:.,'.' !:; ,·, ,J.! ·:~.i•,·-~. ;:J{~ ;.,.. ~l,_... , .; l-'!1! J_:•, iU lft.iJ} ~ '":fCf ()~ f;)t1J !:~ ~•~-C:~i.h'..i·.. YES· NO
~ · D D 1 F00f1M55 9 3 -Jt For Navy, Marine Corps, and Coast Guard use: Will be used in lieu of DD Form 93.
/
I. DESIGNATOR'S LAST NAME-FIRST NAME-MIDDLE NAME
NEWHOUSE. Delbert Clement
• RECORD OF EMERGENCY DATA
SEE INSTRUCTIONS ON REVERSE BEFORE MAKING ENT81ES
2.. PRESENT SERVICE NO•
17728'3
.. I 3~;RATE 14·;~;
l..;-·1
I 6-~-13
S. DATE OF BIRTH
6. HOME ADDRESS AT TIME OF LAST ENTRY 1Ntp SERVICE (Citv, countv, and State) 7. FORMER SERVICE NO,
Garibalcij.,Tillamook, Oregon 393 07 21
DESIGNATIONS
FIRST NAME-MIDDLE NAME-LAST NAME ADDRESS RELATIONSHIP
8. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
3581 SE Grant Court
Norma Isobel NEWHOUSE ~ortland, Oregon Wife
PRINCIPAL
PO Box 127
9. BENEFICIARY FOR GRATUITY PAY
IN EVENT THERE IS NO SURVIVING
Edith May RICHTER Garibaldi, Oregon Mother
SPOUS~ OR ELIGIBLE CHILD
CONTINGENT
Rt. 6, Box 756
Darrel Edwin NEWHOUSE Tacoma~ Washington Brother
SHARE
10. BENEFICIARY FOR PRIN-
s Not Applicable. NSLI
SERVICEMEN'S INDEM- CIPAL(S) SHARE
NITY( PL!S,Bld Con•
(lrua) ( AU prior dea- s
ignationa are canceled.
Deaignation for in• SHARE
demnitv dou not afect
inaurance ( NSL or s
USGLI) benejiciar11 CONTIN•
deaignation) GENT(S) SHARE
s
SHARE 3581 SE Grant Court
II. BENEFICIARY OR BENEFICIARIES
• FOR UNPAID PAY AND ALLOWANCES
100 % Norma Isobel NEWHOUSE Portland~ Oregon Wife
( PL 147, 84th Congrtaa) SHARE
%
12. PERSON TO RECEIVE ALLOTMENT
OF PAY IF MISSING OR UNABLE TO
PERCENT OF 3581.SE Grant Court
PBQ%CHMO.
TRANSMIT FUNDS Norma Isobel NEWHOUSE Portland~ Oregon Wife
13. PERSON TO RECEIVE PERSONAL EFFECTS FOR
SAFEKEEPING
Commanding Officer
14. 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 State Life
Insurance Company Sacramento, California 399422
'
FIRST NAME-MIDDLE NAME-LAST NAME ( If dectaaed, ao atatt). ADDRESS
15. FATHER
Noah Franklin NEWHOUSE Unknmm
16. MOTHER
Edith May RICHTER PO Box 127~ Garibaldi~ Oregon
17. WIFE OR HUSBAND ( If none, ao atatt)
Norma Isobel NEWHOUSE ~~81 SE Grant Court. Portland 15. Ore£on
MARRIED
NAME OF CHILDREN ( If none, ao atate. Ifatep or adopted, ao atate) ADDRESS SEX
18.
YES NO .. DATE OF BIRTH
Delbert Carroll NEWHOUSE 3581 SE Grant Court, Portland,
Oregon X M 6-28-38
Anne Lisbet NEWHOUSE 3581 SE Grant Court, Portland,
Oregon X F 3-14-40
19. ORGANIZATION AND ADDRESS OF DESIGNATOR 20. DATE SIGNED
Uti1 i tv Smu:i dron FIVE. NAVY IJ-:~8 ~~.. cl o FPO. San Francisco. California .,. 2-911~6
21. SIGNATURE OF-WITNESS
~~1. A,~ ,~~F, r N ~ T O
l,I H:"MHl\rt
-
NlllH
-
r~ •·~ - -- ._'!-:_ ~~
,f.W~NR-R 1nn RH·i-•· :f
DD 1FORM 93-1 OCT 55
For Navy, Marine Corps, and Coast Guard use: Wlll be used in lieu of DD Form 93.
RECORD 01' EMERGENCY DATA
SEE INSTRUCTIONS ON REVERSE BEFORE MAKING ENTRIES ~~\ r
1. DESIGNATOR'S LAST NAME-FIRST NAME-MIDDLE.NAME 2. SERVICE NO. 3. GRADE OR RATE
(:1
NEWHOUSE, Delbert Clement 177283 CHPHOT USN
5. MARITAL STATUS 6. FULL NAME OF SPOUSE 7. ADDRESS (Numbe', atrtet, cit11, :one, and State)
Married Norma Isobel NEWHOUSE 3.581 s.E. Grant Court~ Portland l.5 1 Ore.
CHILDREN (List each child of any marrialle. II none, so state)
FIRST NAME-MIDDLE NAME-LAST NAME ADDRESS MARITAL STATUS SEX DATE OF BIRTH
Delbert Carroll NEWHOUSE 3581 S.E. Grant Court, Portland l!~, Single M 6/28/38
Oregon ,.
Anne Lisbet NEWHOUSE 3581 s.E. Grant Court, Portland l!~, Single F 3/14/40
Oregon
9. NAME OF IJI FATHER OR O MALE GUARDIAN 10. ADDRESS IF LIVING-IF DECEASED SO STATE
Noah 'Frank NEWHOUSE Portland, Oregon
11. NAME OF~ MOTHER OR O FEMALE GUARDIAN 12. ADDRESS IF LIVING-IF DECEASED SO STATE
Edith Ma.v RICHTER Box 127~ Garibaldi~ Oregon
IN THE EVENT THAT I AM NOT SURVIVED BY A SPOUSE OR aIGIBLE CHILD I DESIRE THAT PAYMENT OF 6 MONTHS' DEATH GRATUITY BE MADE TO
THE RELATIVE ~HOWN BELOW. (The namo of lather or mother must be repeated ii it is desired that he or she recoivo payment)
13. FIRST NAME-MIDDLE NAME-LAST NAME 14. RElATIONSHIP 15. ADDRESS
Edith May RICHTER Mother Box 127, Garibaldi, Oregon
16. ALTERNATE RElATIVE 17. RELATIONSHIP 18. ADDRESS
Darrel Edwin NEWHOUSE Brother Rt 6, Box 756, Tacoma, Washington
19. IN THE EVENT THAT I AM LISTED AS MISSING OR OTHER MILITARY CIRCUMSTANCES PREVENT ME FROM TRANSMITTING FUNDS TO MY DEPENDENTS, IT IS MY DESIRE THAT
FIRST NAME-MIDDLE NAME-LAST NAME RElATIONSHIP
Norma Isobel NEWHOUSE Wife '
ADDRESS RECEIVE EACH MONTH
3581 s.E. Grant Court, Portland 15, Oregon 90 PERCENT OF MY PAY
20. I REQUEST THE FOLLOWING COMMERCIAL INSURANCE COMPANIES BE OFFICIALLY NOTIFIED IN CASE OF MY DEATH IN ACTIVE SERVICE
NAME OF COMPANY ADDRESS OF HOME OFFICE POUCYNO.
Pilot Life Insurance Company Greensboro, North Carolina 321583
California Western States Sacramento, California 399422
National Service Life Insurance Veterans Administration, Wash., D.Ct V-77-44-.32
Government Life Insurance Veterans Administration, Wash., D.C4 K 948 857
21. DESIGNATION OR CHANGE OF BENEFICIARY-SERVICEMEN'S INDEMNITY (PL BS, sed Cong.)
(Dou not operate a., a designation or change of bemjiciaru of anu insurance contracta faaued bu United Statea Government)
ALL PREVIOUS DESIGNATIONS OF PRINCIPAL AND CONTINGENT BENEFICIARIES, IF ANY, UNDER SERVICEMEN'S INDEMNITY Ar::r OF 1951, ARE HEREBY CANCELED, AND IT IS DIRECTED
THAT SAID INDEMNITY BE PAID TO:
NAME RELATIONSHIP SHARE OR AMOUNT TO EACH BENEFICIARY
Norma Isobel NEWHOUSE Wife 100 per cent
. r1 I /'\ (/"J
WITNESSl~D.
'na1~~
.. ~s g G N A ~ ~ ~ : J i n L-4J
G. L. LUCAS
GRADE OR RATE OF WITNESS
Lieutenant-USNR- R
I SERVl;E;~572
DATE SIGNED
30 March 1955
DD
1
~~~M52 9 3 Replaces ~D Form 93, 1 Jul 50, which may be used.
l&-67492-1
j
I
- . -- -
- -- .
o. o. vou. No. --1&.l'f:,j!J- -
( ForSX~~;fic=::r=.~ >
------- AMO~NT
001.1..ARS CENTS
--~---..c...-,_,,.,.,._.,-_ _ _ _ - ~ - ~ - , . - " " I
.
-----------------
109.20
.
PAID BY CHECK No.
- - ACCOUNTING CLASSIFICATIO~compldion byAdmini• lrali••Officcr) -- ' -
APPROPRI ATION. LIMITATION
APPROPRIATION TITLE
OR PROJECT SYMBOL
Payment is requested for transportation fo.r travel performed by the following;whl\ ~fe my dependents on the effective date of orders
<ilr!!£!ingJbis-ch~ge Qf s4!!_on, ' . • ._ r . _ _ ~\ • , : . ,
., .
•· , .... '-;:: <
. t. d ,
I certify that rny epende~ts were located -~~.£:.:..u."""'~-"-~...A~----~~ ..:.:.~-=~=-=-=-- when orders ~irectinfl detachment
0.,l
from my old permanent station were received, and departed from that place on (date) -16~,1-~..,:
,-;~..,._-'11BF----'"--"--:'--"'-c:----::----=:--
3581 &.t. ~ ~curt, ~ - - - --
and arrived at :icrt"t • ~ , C'rrt!. on ( date) _ __,_6"'/1""""4/¥-;;~_.t._.;------- further certify that my
ccJira nd SlfJle)
depeJde1n't~ f~v~lecf~t ~t 1
o~n ex'.leGn\J?1ld ~h'li'Nifl?Nhilj:l'tSi~1~"re~) J'a'.'rJJ'Yltii~ll~'(fr45 tht;J 1tgitifui te'-'cttiicJ1(cl1il18hih'jH thl¾"officer or man
concerned. (IF CHILD (CHILDREN) IS (ARE) STEP OR ADOPTED, FILL IN CERTIFICATE ON REVERSE SIDE.)
,, 2rcr H;:r · c:.1 \•brE 1tri D~ t;,f.b2 .1 <:'GE I HEtr
I certify that the travel covered by this claim represents the entire travel of all my dependents which has been or will be made on this
fli t' <lU (
I j'¥J:• j l" C, ~ :f P. ·mwrdu ~) {0 'o 0 1/ 1il II\. 2 ,!IJq V i:..C'' ' i'>J ~ t r::
change 6n;ta'tiorYe'xcept!e.'sfdlld~iH II I') t a n<,vn ~io1: r ciq 1- 111< •'1.1'0 '1 ' ?. , nN'""'t~·:•· ') • 11~ w • il!'J: -u- · n JC • ' " "; ll'
DATE AAN~ QfO,R!>,,"lilNG
•Jf applicable see Instruction 1. ~(Instructions on reverse side of form,)
J
.u ,, r
O'<f.• l"
<'krA
1
rf th~•'el;elit this-claim- involvesTraver under secret or confioemiat°orclei's,'crr61'tttl"ITT'l'b~ o t : l l . t r 0 l 1 crf-th·e ·o_ld o-r· rrevv-dvty
~ 1~~;:;i .~•I
station is omitted for reasons of security, or under orders effecting assignment to or from sea duty or to or from a place to which dependents.
arll not permitted to go, careful attention should be given to SecNav letter of 23 December 1944, particularly paragraphs 2, 3, 6 and 10.
~ <+S~uUJ.: ... vi •,~ •&, C<'UGrH·' L'>Ul'Cf ., ... ,of • ,,l {OlUJ1,q p). \IJi\ qGL>Gi.,q.;u, .; •
~.tH\i~uV'J,~i~. is ~~t"s Jbmftt~CJ'\;na~, 's'e! Na~ feiW'lft
2aqdC2eatlbe~ 1g«'W~stfqc{i~~~ ',l>a'tfove):"tWe drigi'r\a:t bn'a two certi'f1ea 1co'ples. •j
of all_or__9eLrs) nv;~ly·!El,,dJ11,w,Jith all eJJdorse.rn_ents, must acco_mpany <:;la
__i_rn. __
'I ~ ,.,.>. - ,. -- - •• ..,~ t cu,r - "'~lC ' 1..••1,~~l.,')"•\HJ "'· (~ "·l• ;_7c; I f"f'-l_: .,q
3~ G.laim:S.heuld be p-rep~d ,.and•fo-r~rded to 8JJf,l~~U,;.Ofof'l4.Yt1: P.HlS~NN1EL.:,:Lw~s.nJn_g!Q.n M ,"D. C., in accordance with Article
3s~. ~- S. Navy Travel Instructions.
q, J -1,. CL~l'M MlJSll BE SliJBtv'llTTED rN ·QtJADRlJPt:ICATE:- ·The original is to· be crn NAV. S. and A-. Form 91-2-Rev:-and-s'igned in
ink on the face. Three copies (unsigned) to be on NAV. S. and A. Form 913-Rev,
' C 'il. ·~· i ' t- 1 ') "'I ,.,., LG" ~', f : . C !liJ 1 ' ,, ?O.. f ? jJC' ,,t,,,
t; '-"MJ O{ !!IJ wi, QObi;uqG'IJp; MjJICII f'IU! 'V"' l!J(): "'!I
I •
f.•t' Wl.Jqd Ol' ff'!2
5. SECURELY STAPLE ALL PAPERS TOGETHER. ~
1
L!rq ,._ ., 11, -:::• -o <cH·,-01:5r,_,,i f._ 'o'~f I'? E b Ot:S ,,'QOc..LE':D' l::. lrr l ,i Cli:t<i..t. 1 l:.i•~\" J .E: C,1 L:,E,,Ctiii!F. Z I D E : ) ,
·, ' 5":• T,,he space
r 7,.9('..1 i .\ t'''' 'b .•l d, ,..,,,,r;ri·~ 1c1 •,,-;;=1J,1)Q(J:P'14_l.' i \1::-u·r.
be r·ow as o e use tor any aa tIona· fntormataon oy cr••. rt10 ,;.::,h.t,h
w Ic • t,;Is\rur.,1'\-i1.11•l''('(;Jl'"/l';l11,nf
necessary in sen eme·n i o '•l!• -cnIs•fJIca
J'.Jl"·
m.'li'="'PLi-JJ~U
- - -------
. aIman,
1 ~t 1l'ht ~ ~\)
_.
• I
-- 9a.Ul 't9 G~1 1'L :. -- - - - orme VJ.a, governmeEt vessel fit9m _$an_.f~ancis_co.,1-
- ___ ,:,; furtner cer·tify that::my depen -t _._._1_____
~
- - . . . . - . -.. - -
'Vb
cr5 i ·~-"'UJ. e.-.J r=.1..i.r
Obt..' 1 •.U"''~- 1'.l* , 1v.1.1c:.
1 '.JI ..11,i;O:,.t!IYJ..JOl .f LIJIT
- - - <J't'2~Jl:.tcvuc
_______
vcc.on
---- ----:~. ---~-
......__._ ,-- ,_c., ~ ·
~ •JV.<! -\ - - - - ~
..
CERTIFICATE OF DEPENOENCY OF CHILDR§S!
,.
(N~: To be taed onl11 for ~ or ~ childf1n) l
"
C"•.1:.i!)J,.' - -~ certify that - - - - - ~ -- . is (are)
my (ado ed) (step) child (children) and is (are) member(s) of my household; that said child is (children are) not possessea of property or
i,n,..co,r:ie.a_ ~ate5for 11.s (~h~ir) _supp~Tt an_d _educatio.!!_,th~J.! i~ ~~y ar.~~not_the! eQeficiary ~ ben_eficl!'.r!'es.. ~ith~r directly or through others,
11Pany tru or estate entitling at (them) to ans;ome adequate for at? (their) support and education; that said child Is (chi ldren are) in fact now
and at all tin,es solely dependent on me; that in all respects I maintain the child (children) at my.own expe~se and from nw own resources
~ni.1-a~ 110:t reim-borsed ther~for directly o_r indirectly in any manner or !~m w~a!s~ev.::,; ~d,that. evide!1c~ of the child't (chllaren's) de
pend_ency on ITlr ana my mamtenance of_ ,rp~em)1 ~~ bee!!Jfl~-d ~'fil!~~.'J?Y.-P~ ~ff2£l .1Js. w <&i~: lfer~by'ma_de f1.:Jl?~ l lfereof: (See special
requ1rel)lents, Art. 2513, U.S. Navy Travel nstruct1ons.j f
t' ·, r. 1 [ ,, ,It ~ l JI" f ' ~ ,.' 1ill"JJ;; r')' t"O,.'l':
•-~,1 • ., • .:. .... . .,. r_:,, ..r~ • ,_ '"' ~ - ··
C • ~.J •• " '
1:0• 1.u -. ~ "'i ~ - .,, ~
i .-•.' ,. ,:, 11 • , "' 1 l·.'):l·~'J_] ' f §HGNAruR·E' ~,,., ;•
* u. s. GOVU NNlN:t PUNTlNC. or,1cc 16-44896 - 1
I I
12:;;,::f'(!~ Y•II Jk ~s:.,H
IP r
l!n n e L1 s h <> f&k1<
1
zl
-iei- St e p chi ldren or adapt ed chi l dr e;"° must be cl as sified~ s uch . Dependent parent
must be cl a ssified a nd cl a imed a s such .
11 I c ertify t hat my dependents wer e loca.ted c1,t / 9t/f l4r.ivJf -lier/2:el-e i:;
street Addreis , City /
__Q
_ ..;:
g......_/....:_.. _f. .-•·____ ·when orders directi ng detachment f rom my ol d · permanent stf!tion
S~ t e /~ /
wer e rec eived , and de parted ,fr om that pla ce on - W °-YL--- - - -•
Date
➔Hi- -:_Y(- -,..y~ -isi- ·lH!- ~-l!- -:H!- ~h~ ·)8!- -l!--l~ -l8!- STRIKE CIJ T ]F !JOT APPLICABLE -,..'-¾- ,'!-' m'!- -:Ht-
.'.l l1d o.r rived a t (Po i nt of Sel ection)do- 8'1 Si:i.~G~tcwc:l:1.,:;,.
hfi :...\..:.:S..!..
~.!- l #.Jtl.~~~'-i--l~.....:.;,~ ~on
r / street Addr ess ,
J//_f/2
_0_,f/
,_-_ ,:,______und depar t ed from that pl c2ce on._ _ _ _ _ _ _ _•
~ e ~~
and ~rrived at San Fra nci sco, Ca lif on ________ ar1d d eparted there on
Date
,_ _ _ ______and a rrived on Guar:1, M. I. on ________Addr ess on Guam
Date
--------------------------
Compl ei;,f3 address
r•
. ✓
11
11 r 7bertify
th~t my de-pendent ~ wer e l a st or r e:imbursed a t Govern-
men_t expense for t rav el t o_ od !(· 11. C
........~CL
"'il."'4
l""y·
Ir,.:..:...L..J..-
'-,J;M"•
J ---=-.....:.- s.., 3:
/
~--t-e- - - - -,
II •
NOTE: Thi s dat a sheet i s to be ..p r esente d to the disbursi ng off i cer wi th the origin::i.l
a nd t hree certifi ed copi e s of trn.v el or der.s , v:"it h n.11 endor sements . The
11 Vou cher for Re:imbursa uent for EKpens€s I ncident t o Depende nt Trav el 11 (NAV.
S. AND A. JFCR1k 912 Rev . ) will be s i &,n ed when c anpl ct ely fill ed in , Thi s
"Data Sh eet II or t he VVouchor for Re imbursement · f or Expens es Incident to
Dependent Trav el 11 (NAV. S . AND A. FORM 91 2 Rev .) wil l not be signed in bl rulk.
11I furth er c;: er tify that a ll entr i es mad e above ar e i n my o,vn ha ndwriting and
a r e true ,1nd cor r ect; t hat I ha ve r ead this compl et ed ct.:1.t a sheet and under
st a nd t hat any misr e pres entat i on or conc e.:i.l ment pf mat e r i a l foct by me may
wor k a .fo:!J'feitur c of t he cl.1. :im nnd subj ect me to t r i al by. cou rt ma rtial or
Fed er al District court and to p enalt i es extending to fiv ars imprison-
ment or $10, 000. fine , o r both" .
}: '1 -,• ,-,,,f"' k lfl • "'
1
1 'M 0, " ' · t' .,
NA?s.ANo A:'. Fii""RM 9T~~- -,..---=-=="""" VOlfC"lfEfr F:OR.,.Ji.EJrvJBURSEMENT
Form Prescribed by • ·,,- .,,;_ ~
Comptroller General, U. S. FOR • •
17 1945
May • XPENSES INCIDENT TO DEPENDENTS TR
16 111
' - " r,LLJ.)'T.!' •~L.i' )~J3' fl ?' Vl" t.h .Ll ,,r-.t,ili:'1fgci1.,~i1'~b OF NAVAL PERSON~EL, WASHINGTON 2s, D, c •
.,, '• • -- · ·- •• • • ' _., •· - . ,~ t ·- .... • • -
J'pf'iEl UN•l'.f'-:,Ci)JSmA'rf!$J.1DRV ~y,r ·1.-. 01 1, QI,• ' ' , ' · n ·ru'I.
,11,,1 \J~ ';I( 'IUJ(; . ('. • • •
''lrcP{PRI~~;.:.
'':..
·· ~ .:,:.:i
· t.!t:.1~~!..!J~:.1!!.::....'..£:'..~~:.:l!i::!C~:±!...:.:.!.:...ll:4µ!.lt!.!!.:.:~:.::i.=4.l!X:::.;.,~~H~~~.!:.£!
!llCO:JJv 1' q1,dn. !'°(
L I A :1,t•ol•! I T', .11.
OFFICIAL.ADDRES::.....__,__,....._,:--i~~""";#z::i:!;S~~~~r.-;;-:-- - - - - - ; : -T - - - - - ~- ~ ~ --,-~
(rn"'rf/&;;f Pciihti'Offlc°iir).~.
,-------------=
AMOUNT
,,.
-· ~-er
- - - - - - - " ! - - ~ - - ~ ~ · -·- - - -
DOLLARS CENTS
--------- J --r~
. . -------·MEMORANDUM - -
- ~ --+ ...-. ........ . ·- - ..;$:-.-------.11
'1i.aO..,•,,...,,,:;~~.--_-
PA10 BY CHECK No.
--- ___.._ ___
ACCOUNTING CLASSIFICATION (For e<nnpllltion by Adminutratiot Officer) FARE AUTHORIZED
APPROPRIATION, LIMITATION FROM
APPROPRIATION TITLE
OR PROJECT SYMBOL
RAIL
TOTAL
- - ---r-
. __ . CERTIFICATION OF CLAIMANT (FILL IN ALL BLANKS BELO
• Payment is requesteg for transportation for' travel 'p erformed by the following, who were my dependents of) the effective date of orders
directing this change of .station.· L
NA,ME RELATIONSHIP DATE OF BIRTH OF- CHILDREN
from my old permanent station were received, and departed from that place on (date) -4J-l-f~.,,,_:--,!l••P~-------~---;----'--
,. ..... C' - .• t
and arrived at ..,...,1,-,--,t.,;..,1:?;1,c5;r,;.._~1::-=...__,,"i=:,_;:..·:;c,•~ - --=----'--:..:...- on (date) _ ....6~,#-'1"t,.;.,,:;
l.,.,,_/.;,..~/-!r->..c....-- -- - - " further certify that my
, (biti,inJ 841i•) 'f"" •
dependeHfs lraveletlfat,.r/l°y ijv.[n,e'x'jfebs.e>,l attJ\tnaf tfi'e•chijcf i(cnlld'fe~·Hr?amecP·b litMfist(a;e)l ttfe fo~lflmate etl,~ldl•(obi4c;lrl}n) of'1!he officer or man
concerned. (IF CHILD (CHILDREN) I S (ARE) STEP OR ADOPTED, FILL IN CERTIFICATE ON REVERSE SIDE.)
~- 2E ...fH,~1A 2_;'brF \'IT b\'~fi:lc l Oe [ J.HEl:5
I cer-tify that the travel covered by this claim represents the entire travel of all my dependents which has been or will be made on thi s
!U1< /'IP P' 1·1ci: ,Liff.I" ·•r,\)!{1 ~' ,·11i11~) {O F t,1; t · ~ ,\. 2· !l'i v· 1:,0, ' ;, 1~--(df' •
cha1;1g~,N atio!1, P,'lFfPll-tste 1.~ll'!Yf1:dJ' '.) r.. o r,.- ._ ,,_;n r ,.:,u( i J, u ·1 !e ;.. µ ' Qt,,,, G ·,• '• t. ,,, J,,;,-- ~~,. -~ y ,~.
- ""rfapp!fca~le see"lnstructlon -1 .
g~,t,~,o,th~,-~V~l\t this claim iAYolYes travel undeF-SeOl'&t OF oon~Rtial order-&r-Qr- oi:der& frcHR•1111:Hch-.tlle..loca.t ion of..the old. or-new dut)(..
s'tatio'n is omitted for reasons of security, or under orders effe_
c ting assignment to or from sea duty or to or from a place to which dependenfs
are not permitted to go, careful attention should be given to SecNav letter of 23 December 1944, particularly p~ragraphs 2, 3, 6 and 10.
), ? l , I'll•• ; J r 01 '.1' ,, C,l <; l i'{l•:q l<lt,81, ~ I <>•WC l O). t:J}. C)+;l)<auq&.i,r•
1
2. q1 yolirdaim'.rs fu,f''!llbmltled ,un'd~'r SeoNav •letter•()'f,231,li)e<!l!tr1be'1194il-. (l'n6tructtonJl, above), tl)e.6,,lginal and two,certified copje
of all orders involved, with all endorsements, must accompany claim.
. I ;1~ i.• ,A ·, 1f'i "Ji(.;, ru, ,. •Ji. re· ... ·10. ~ c 11,ti • "· .:·tt·
3. Claim _should, be prepare,d and,,forwarded to BU REAU OF Nf>,,V.AL PERSON_N EL, Was~in~on 25, D. C., in accordance with Article
2513, tl. S. Navy travel ln~tructions. ' ' -~", ..c. ''•! f ' ~ ··\ '- ~,·.•,I' • J<- '
.,- 4,. GL.ti.lM MUST:b~E St,JBt:,1JTTED IN QUADRUPLICATE. The original is-to b8-on NAV. S. and A. Form 912-Rev.and signed ln 1
ink on the face. Three copies (unsiined) to be on NAV. S. and A. Form 913-Rev.
1 ,., _.., f· ~ •• "~ ,;, , , i;C1 ,\ r, '' '·l . 1 , h'l? ,·~ f,Jc "1;1 . ;; (1,:;;~Q! ol ~1, ,,, ), ~&Lt 1qt.rr~-h~tJlq1 (,~,. ,,ncu, <.1L ,~HI p,} w!rqc ou •P!i' f
5. SECURELY STAPLE ALL PAPERS TOGETHER.
1
' 1 , , , 111-oh.. r-1,' 1 : ,l~F. .->JfbO<J"OC·bl":C L ' ""rtvC..,'-L.i,: ! Ov.8E L,c:_~r•l..'
,_• 6.' The' spa'ce'lbeile'w'is td beCusecf for any ,a'!lditiooal'iriforrH~ior\J I>)> 'cf!iflrfant' whlch is,n'eces.sa~lin ,set~len)enprof.,this olai.m.ot~!C_;._ 01.. w~:i
1,l~t, J.,l u 1 b, ' J H~t J":J~r •.,,;•. ti r, _,. ;' ~ ~-;b•'l.tiq ~- OVJ +µs
.
I cert:uy, exceot as noted hereon < that., · · •
• ,by me or h'y 'b.~•·· ~o.::.b~i· of my
f ~ ~ t h e -~ .pr:i._o~c.laam-has,.;beepli)r.es~nt..~dt;µwc;u♦
dependents R~ c.;.-:1.;.r.,.2 ~; ~"'i·ein and that reimbursement, fer transportation of
e.xpense
• ,na-t -no
- · ... ... •· ~ - · n anu. t·'L
as ·1 -: -:~~..J, ', .• ,.,o - t:.izy- clependents
r.ansp.oxta.t • -traveled
• -, . , -v ewn perso--:1
at-mv- •.Id,,,,\.
___
with the exc0~:,J.:.i .~ of travel performed . . J . . ~ Ji~s=been fmnisnea ..
Calif· to Guam •; M.:.- - via1 goy_e..rnm.ent...;i:essel.- flro.m-San Fra.l'lei-scor--
_.., _ _
• !'- -
CERTIFICATEOFD.EPENDENCYOF CHILDREN
(Nau: To ~ ,...d cml11 for adopted or ,up children)
.,.-,---f
I)
I
I ...,,.,,--.,,,.r-.......- - - - - - - - - certify tbat is (are)
; ;1 :ci;pted) (step) child (children) and is (are) member{s) of my household; that said child is (children are) not possessed of property or
income adequate,{or its (their) support and educatiof); that it is (they ar~) n.ot,the beneficiary or beneficiar.~11s, either directly or through others,
o'r·ail.ylfhJsforestate entitling iC{ffiem,1o income adequate foriUTtneTr) support and education; that saidchild--is (children are) in fact now
and at all times solely dependent on me; that in all respects I mai~in the child (children) at my own expen! e and from my own resources
and·arrt/10 ~mbursed therefor directly or indirectly in any manner or foa, w,!iatsoever; and that evidence lof the chilq's (children's) de
p~ndency on me and my maintenance o-f )t .(.tlrem) has been filed with my pay acc?unt:;;;a.rnl if _hereby made a part thereof. (See special
•
requ1tements, A'rt. #,513
~ , U. S. Navy T raveI I ns
' t ru
" ct'rons. )' I ' ' .I ' \ " U,.l •
· L •~ I, ,\r' l' l
, • " • "· ~- : .., • • • t'I ,.,:-. 'i; .l.b o· i:> -1n· •• .....----,--
"... • 1 :a.. ....... ..--:.1 - ~
' , • or • • SIGNATURE .......___
U. I. COvtll NCM-1 PRINl flmA_~l
\.
·--
RECORD OF EMERGENCY DATA FOR THE ARMED FORCES ·o . ·HE UNITED STATES ~
INFORMATION INCLUDED ON THIS FORM DOES NOT DESIGNATE OR CHANGE BENEFICIARIES OF LIFE INSURANCE POLICIES
(See Instructions on nwene lldo of form prior to making ontrln)
t. DESIGNATOR'S LAST NAME-FIRST NAME-MIDDLE NAME 2. SERVICE NO. 3. GRADE, RANK, OR RATE 4. SERVICE D USA ~ USN
NEWHOUSE~ Delbert Clement 177283 1 OHPHOT □ USAF □ USMC □ USCG
RELATIONSHIP ( Iffriend, 10 ltatt)
5. FIRST NAME-MIDDLE NAME-LAST NAME OF PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
(Per,on with fatrmanent
addre11 ia ado aable) Edith May Richter
ADDRESS (Number, atreet, citr,, and State)
r~\
~
Mother
General Delivery, Garibaldi, Oregon
THE PERSONS NAMED IN ITEMS 6 8 AND 9 BELOW WILL ALSO BE NOTIFIED OF THE EMERGENCY. IF SUCH (NOTIFICATION IS NOT
DESIRABLE, DUE TO HEALTH OR FOR OTHER PERTINENT REASONS, PLEASE so
STATE UNDER "REMARKS" ON THE REVERSE SIDE.
6. SPOUSE (Fir,t name,,middle name, laat name) ( If none, or if deceaaed or dloorced, ADDRESS (Number, atrect, citr,, and State)
ao ,tate)
Fuente: archivo UAP oficial del gobierno de EE.UU. (dominio público) · war.gov/ufo ↗ · ver en el archivo de Nodriza