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1104- 3
.PPLICATION FOR RETIREM 'NT
To avoid delay-1. Read information carefully; 2. Complete application in full; 3. Typewrite or print in ink
A. PERSONAL INFORMATION
1. NAME (Lost) (First) (Middle) 2. DATE OF BIRTH 3. SOCIAL SECURITY NUMBER
MR. (Month) (Day) (Year)
SWENSON Harold Francis April 28, 1915 144-07-7204
4. ADDRESS (Number and street) (City and State) (Zip Code)
CORRES 5005 'gemoor Lane, Bethesda, Maryland 20014
CHECKS
American Security and Trust Company, State Dep. Bldg, Wash, D. C.
S. (A) ARE YOU 6. (B) IF YES. GIVE THE FOLLOWING INFORMATION.
MARRIED?
WIFE'S OR HUSBAND'S NAME HER (OR HIS) BIRTH DATE DATE OF MARRIAGE ADDRESS OF SPOUSE IF DIFFERENT FROM ITEM 4
(First) (Middle) (Month) (Day) (Year) (Month) (Day) (Year)
LwYES
Ol NO Mildred Chandle Ma 10, 191 Dec 31, 1 3
B. CIVILIAN SERVICE
1. OFFICE OF ASSIGNMENT 2 SERVICE DESIGNATION 3. LOCATION OF EMPLOYMENT (City and State)
DDP/EUR D Frankfurt, German (52o
4; TITLE OF LAST POSITION 5. DATE OF FINAL SEPARATION (Month) (Day) (Year) 6. APPROXIMATE NUMBER OF YEARS OF
Operationo Officer May 31, 1968 CIVILIAN SERVICE 20
7. DO YOU HAVE FEDERAL EMPLOYEES GROUP LIFE INSURANCE? 8. ARE YOU ENROLLED IN A PLAN UNDER THE FEDERAL EMPLOYEES HEALTH BENEFrTS
PROGRAM?
YES NO R X YES ONO
C. MILITARY SERVICE
1. COMPLETE THE SCHEDULE BELOW IF YOU HAVE PERFORMED ACTIVE DUTY THAT TERMINATED UNDER HONORABLE CONDITIONS IN ANY OF THE FOLLOWING SERV-
ICES: (A ARMY, NAVY. MARINE CORPS, AIR FORCE. OR COAST GUARD OF THE UNITED STATES: OR (B) REGULAR CORPS OR RESERVE CORPS OF THE PUBLIC HEALTH
SERVICE AFTER JUNE 30, 1960: OR (C) AS A COMMISSIONED OFFICER OF THE COAST AND GEODETIC SURVEY AFTER JUNE 30, 1961. IF AVAILABLE. ATTACH A COPY OF
YOUR DISCHARGE CERTIFICATE.
SERIAL NUMBER DATE OF ENTRANCE DATE'OF SEPARATION LAST GRADE ORGANIZATION AT DISCHARGE
BRANCH OF SERVICE ON ACTIVE DUTY FROM ACTIVE DUTY OR RANK (Div., Regr., Co.. etc.)
U.S. Marine 14 March 7 January Marine Torpedo
Corps 035838 1944 1946 Captain Bombing Squadron
232
2. (A) ARE YOU A MILITARY RE- 2. (B) ARE YOU IN RECEIPT OF OR HAVE YOU EVER APPLIED FOR 2. (C) IF YES, WERE YOU RETIRED FROM A RESERVE COMPO-
SERVIST (EITHER ACTIVE MILITARY RETIRED PAY? (RETIRED PAY DOES NOT IN- NENT UNDER CHAPTER 67. TITLE 10, U.S.C. (FORMERLY
OR _INACTIVE_ _ CLUDE V.A. PENSION OR COMPENSATION.) TITLE III. PUBLIC LAW 8O-RIO)!
Retired _
YES NO LYES NO 0IN YES NO
D. DISABILITY INFORMATION
Only applicants for total disability retirement will 1. WHEN DID YOU BECOME TOTALLY DISABLED! (Month. year)
complete Part D. I
2. BRIEFLY DESCRIBE YOUR DISABILITIES. STATE WHEN INCURRED. AND HOW THEY INTERFERE WITH PERFORMANCE OF THE DUTIES OF YOUR POSITION. (ATTACH
ADDITIONAL COMMENTS ON PLAIN SHEET OF PAPER IF NECESSARY.)
1
E. OTHER CLAIM INFORMATION
1. (A) HAVE YOU EVER RECEIVED OR MADE APPLICATION FOR COMPENSATION I (B) IF YES, STATE THE NUMBER OF YOUR COMPENSATION CLAIM AND THE
UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT! PERIOD FOR WHICH YOU RECEIVED COMPENSATION
CLAIM NUMBER FROM (Month) (Day) (Year) TO (Month) (Day) (Year)
Oi YES L NO
2. (A) HAVE YOU PREVIOUSLY FILED ANY APPLICATION UNDER THE CIVIL SERVICE 2. (B) IF YES, INDICATE THE TYPE(S) OF APPLICATION
RETIREMENT SYSTEM. INCLUDING APPLICATION FOR RETIREMENT. REFUND, AND GIVE THE CLAIM NUMBER(S) IF KNOWN CLAIM NUMBER(S)
DEPOSIT OR REDEPOSIT. OR VOLUNTARY CONTRIBUTIONS! RETIREMENT DEPOSIT OR REDEPOSIT
jVOLUNTARY
K YES NO O REFUND CONTRIBUTIONS
3. (A) HAVE YOU PREVIOUSLY FILED ANY APPLICATION UNDER THE CIA RETIRE- 3. (B)IF YES, INDICATE THE TYPE(S) OF APPLICATION:
MENT & DISABILITY SYSTEM, INCLUDING APPLICATION FOR RETIREMENT,
REFUND, PURCHASE OF SERVICE CREDIT. OR VOLUNTARY CONTRIBUTIONS! RETIREMENT PURCHASE OF SERVICE CREDIT
L YES NO l REFUND VOLUNTARY CONTRIBUTIONS
4. (A) HAVE YOU EVER BEEN EMPLOYED UNDER ANOTHER RETIREMENT SYSTEM 4. (B) IF YES, GIVE THE NAME OF THE OTHER RETIREMENT SYSTEM
FOR FEDERAL OR DISTRICT OF COUMBLA EMPLOYEES!O YES []NO* FBI Civil Service System](ViewImageLocal?handle=hein.jfk/jfkarch39888&div=1&collection=&method=preview&ext=.png&size=3)