Final Personnel Record for Newhouse, Delbert C., U.S. Navy, 1957

Read from the scan by GLM-OCR; expect the odd misread word.

ELECTION OF OPTIONS UNDER THE UNIFORMED SERVICES CONTINGENCY OPTION ACT OF 1953

S-3

NAME (Last) (First) (Middle)	SERVICE NUMBER
177283	RANK OR RATING
CHPHOT	USN
X	USNR
PERMANENT ADDRESS
%Mrs. Vencl Richter
Garibaldi, Oregon	STATUS
CHECK APPROPRIATE SQUARE	NO. YEARS SERVICE COMPLETED FOR PAY
PURPOSES
24
REGULAR	RESERVE
X	ACTIVE
DUTY	INACTIVE
DUTY
 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.)

(S) OPTION 1 $ \frac{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.

FULL NAME OF WIFE PRIOR TO MARRIAGE

LACTE OF MARRIAGE	(City)	(County)	(State)	DATE OF MARRIAGE
HAVE YOU BEEN PREVIOUSLY MARRIED?	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?	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 STEPCHILD OR ADOPTED CHILD

I understand that during any period subsequent to my transfer to Fleet Reserve or retirement in which I am not receiving retired or retainer pay, I shall be required to deposit with the United States Treasury the amount that would have been withheld from my retired pay under the Options elected had I been receiving such retired pay, and if I fail to make such deposit I consent to checkage of such undeposited amounts, plus accrued interest upon being restored to a pay status; and that if I do not combine option 4 with the option selected, deductions will be made from my retired pay despite the fact that all beneficiaries predecease me or become ineligible for annuity benefits; and that in the case of retired members, election of any of the options provided is irrevocable. I certify the above information to be complete and accurate.

Finished File Pers E241

Signature Newhouse

(Sign original and all copies)

NOTED TAPHILATED RECORDS

Subscribed and sworn to before me this ___ day

Virgil A Starr ChloroVSN

☆ G. P. O.: 1953-273402

FOR DISTRIBUTION INSTRUCTION SEE NO. 7 ON REVERSE (ORIGINAL)