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DOW-UAP-D104, Final Personnel Record for Newhouse, Delbert C., U.S. Navy, 1957

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DOW-UAP-D104, Final Personnel Record for Newhouse, Delbert C., U.S. Navy, 1957
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This file contains the final personnel record of U.S. Navy Chief Warrant Officer Delbert C. Newhouse, who left naval service as a Chief Warrant Officer 4, then the highest Warrant Officer grade. In July 1952, Newhouse recorded 16mm motion-picture film near Tremonton, Utah; the film later became the subject of a Project Blue Book investigation. Project Blue Book was the U.S. Air Force program active from 1952 to 1969 that investigated the nature and origin of unidentified flying objects (UFOs). In addition to documenting routine assignments and training, the file records Newhouse’s career progression as a Photographer’s Mate, a Navy enlisted specialty responsible for photography and related imaging work. Project Blue Book investigators characterized Newhouse as an expert photographer based on his naval experience.

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[번역 실패: TooManyRequests] KEY PUNCH OPERATOR'S _ INFOR PLEASE PRINT INFORMA ON NAME La st Fi rst I nitial LiJ c.:, :z SERV ICE NUMBER LI.I Q SOC IAL SECURITY NUMBER z Q 0.. ~ ~ LI.I ca:: = Ci:: NATIONAL ARCHIVES AND RECORDS ADMINISTRATION C-:) c~ c 0 Q.. ,, I = ~ Cl') . C, > Cai~ =UJ en ." "~ .,'' fB = = • > .".. 0 cc !" ! z: =~ 0 ,~. . c.. c.. = = z " ..... Cl') "0 :::, :":; = '\'! 0 LI.I -c.:, zLU - :UI&. :z: en _<_ . __. == C U) cc LU t ::::, -c.:> LU ci cci cJ ci u, U) cC cl ct -. a~.. :. :. == 0 · W a: .... .u .. . ::, ID c= .. ti • ~ This Record • IS CLOSED to Further Filing NAVPERS -774 (NEW 11/ 55) .., __ . ' --....;.1 , RECORD OF EMERGENCY DATA I SEE INSTRUCTIONS ON REVERSE BEFORE MAKING ENTRIES 1. DESIGNATOR'S LAST NAME-FIRST NAME-MIDDLE NAME Z. PRESENT SERVICE NO. 1··;;_: 4. SER UVIC SE N 5. 5 DA /T 6E /O 1F B 3IRTH NEWHOUSE. Delbert Clement 177283 1 6. HOME ADDRESS AT TIME OF LAST ENTRY INTO SERVICE (CUr,, countr,, and State) 7. FORMER SERVICE NO. c/o Mrs. Vencl Richter 393 07 21 Garibaldi, Oregon DESIGNATIONS . FIRST NAME-MIDDLE NAME-LAST NAME ADDRESS jjryant rtoaa ~u~ 8, PERSON TO BE NOTIFIED IN CASE OF EMERGENCY Norma Isobel. NEWHOUSE N.P.,Pensacola,Fla. Wife P • u. tlox u.·1 PRINCIPAL Fn.ith May Richter Garibaldi, Oregon Mother 9, BENEFICIARY FOR GRATUITY PAY IN EVENT THERE IS NO SURVIVING Rt ffo, Box ff'/56, SPOUSE OR ELIGIBLE CHILD CONTINGENT Darrel Edwin lfewhouse Tacoma, Washington Brother SHARE s Not Applicable 10. BENEFICIARY FOR PRIN, NSE ITR YV (I C PE LM tE 3N ,B'S lI dN D CE oM n-- CIPAL(S) SHARE ureaa) (All prior dea· s ignationa are canceled. Deaignation for in- SHARE demnUr, dou not afect in,urttnce ( NSL or s NSLI - USGLI USGLIJ bcnejidart1 CONTIN• designation) GENT(S) SHARE s SHARE 11. BENEFICIARY OR BENEFICIARIES 100 % Norma Isobel Newhouse Same as #8 Wife FOR UNPAID PAY AND ALLOWANCES ( 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. Norma Isobel Newhouse ditto Wife TRANSMIT FUNDS 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. Ifatep 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 a 21. SIGNATURE OF WITNESS 22.~SIGDNESIAGNATTOUR R•E O. F 7/l ~.J~ r.AA~uc_,• - ------ - "'MJ ' -.~.... 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 c. To: • , CHPHOl' \:l-4 Delbert UEWHOOSE, USN Via: Cor:.manding Officer 1 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 MAYG7 1957 Ref: (a) Article B-2206, BuPers Manual 1. This change of addr ess is submitted as authorized in paragraph (2) of reference (a) . 2. My home of record is changed as follows: From: c/o Mrs. Vincl Richter 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 2- MAY 1957 FIRST ENDORSEMENI' 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 [번역 실패: TooManyRequests] To: GHPHCll', vl-4 Delbert O. NEWHOUSE, USN Subj: Awards; information concerning l. Delivered. EDWIN L. KilM Copy to: ,em BuPers (Per& F24) • ........ .... ~.·! .,tJe. 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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 subj;d;; ubs~i~;f my clai~reim~burfseomenrt for travel performed by my depend- t?__--:_t_ MEMBER'S FULL NAME / ~ ---~ - ! ______ ______________/ _Zz~_'F'__J______r;:__~__ 7 (First) (Middle) (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-v1'1L-~--~----£k..~__________3/4~Q______ _ ------------------------------------------------------------------------------------·----------------·--------------------------------------·------------------------------ *Step children or adopted children must be classified as such. 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 2/1_u~__ were received and departed that place on (Date) __ f ______________ ; and arrived at (Street address, city, and _3 -/4/6-___ State) 2J~_~_f_J__Tj __ - _" ----- -J---ef~-------, on (Date) G________ ; 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) [번역 실패: TooManyRequests] ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 _____________________ _______________(Pen~/@~ ----------------------------------------- ----- ------------------ ---" NOTE.-This data sheet 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 Travel" (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 both." 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 l ) I' DESIGNATIONS FIRST NAME-MIDDLE NAME-LAST NA~E ADDRESS RELATIONSHIP 3581 SE Grant Gt. 8. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY Norma Isobel Newhouse Portland 15. Ore. Wife P.O. Box 127 PRINCIPAL Edith Mav Ri·chter Garibaldi. Ore. Mother 9. BENEFICIARY FOR GRATUITY PAY IN EVENT THERE IS NO SURVIVING Rt. #6, Box 756 SPOUSE OR ELIGIBLE CHILD CONTINGENT Darrel Edwin Newhouse Tacoma. Wash. Brother SHARE Not Aoolicable 10. BENEFICIARY FOR PRIN­ NS IE TR YV (I C PE LMEeNs," S B tI dN D CE oM n-­ CIPAL(S) SHARE 0TtS8) ( All prior dts· ignationa are canceled. Designation for in- SHARE ' de ,nnitr, does not affect -NSLI·· ..,. ·USGLI ·· · · -- . inaitrance (NSLI or 5 ;U deS sG igL naI) ti onb )e . ne : j ,i 1c . iarr, i GC ~O ~N :T r(IN s)- , 1 S- H- A- RE- - (•- t- ,+ i, = •,•.- •:= ::.:= ·,J.= ,••-- '. - :. ;1. ,- v= ·•= :•;: ,:; ..:::.:::;:= :.:.· . [- -U- ·- /?- ... l . ;. ,. , .". E. !. l- -- :- ~ - •, - 1- .- . :- .-1 ,:;_- ,,- Jl- ''i- ---- :- ::- ::- • --r,,, -,_ -+---------1 , • •• '.I ·r : • . _! :;' 1 ~ ,~'l r •t :' ; . ;·• ,,j ' :;' c· :· :> J- J, ·, . ~-; \ ,. ·~ ,.. 1,r t;- ~:, ~f :' ,i ;' 1 ..[ ]1 ~: 1- ., !~< ~r ; J., :., -1 -,-1 .~, i lj j; ~ ,·i ;f ·~ ,·:' J·: {~ -. ~·; ~: n, : cI.I : ~.'• t-,· :3· JI if{I:,._.:·.- i~' ·- ·~ ;•! ,~ J) ~," •:: i :"~ !f; ,_,( ?, ' .~l '_!~ ;•; ·t ··~ · ·-Jf~~~:\ 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~\•;,• '·Noah i~ahk' N~\~h~{i;~e''.>L!.i~);~.r:.:l.:;:;_:}/;1,'.·i·\,f,1 ,'.: T~J a:r.J cs·· o + m,· a, , : _ 1,,i,. W J.;. a:l.• s'H h} i;1 n. ~•··• o-a_ n1i'. 1 ;< i· '_ '; :;- -; .· • <1 •,L . -·( ~·, '~ •1 i •i'r ,; .• . • ,1 f : .-r : ;· ,1 ,· ;; -._ :: •; 1; !'( 16, MOTHER: ,,,· <;: ,.: ! •. :: '.·.I '"'''"''•'; :,,,i.:; j•'• ,,,.I,,_·,.: ., f.Jl' E• ·d,·i•· th1.,:;-~::M·· 1 avj1 •:· R.;if,i c'-,h.·1,t!'fe ,-~r·~· .: ~f! .. 1, ·i .~7/.!;,1,q •.•. q I 1 l~~J,"'.L. '!''·!,!.'. {') Ji;c,,i",, ;-pr,•: 'lli),'if;:.-:, 17. WIFE OR HUSBAND ( 1/nbnt; .roitiilei ': •. I1.1.;,,'.· '.:!)'; J.••i :~ 1II,:,· ,' • 1• :: Nrt,t1o; rt i n(j,. a,; ·,-. ·1 ,I,.sobel'.;Ne,whouse n,,. ;.;1,..... : j ·,. ;,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£ 1[).lJ:f~q f ;r,. ~'_.;;c; :r1~:\,;_ [번역 실패: TooManyRequests] 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\:tE0 0FlBIR1lt •• ~:-: f,., ·,- if I,:.,'.' !:; ,·, ,J.! ·:~.i•,·-~. ;:J{~ ;.,.. ~l,_... , .; l-'!1! J_:•, iU lft.iJ} ~ '":fCf ()~ f;)t1J !:~ ~•~-C:~i.h'..i·.. YES· NO · D D 9 3 -Jt ~ F0 fM For Navy, Marine Corps, and Coast Guard use: Will be used in lieu of DD Form 93. 10 1 55 • / RECORD OF EMERGENCY DATA l..;-·1 SEE INSTRUCTIONS ON REVERSE BEFORE MAKIING ENT81ES 14·;~; I. DESIGNATOR'S LAST NAME-FIRST NAME-MIDDLE NAME 2.. PRESENT SERVIC.E .N O• I S. DATE OF BIRTH NEWHOUSE. Delbert Clement 17728'3 3~;RATE 6-~-13 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 3581 SE Grant Court 8. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY Norma Isobel NEWHOUSE ~ortland, Oregon Wife PO Box 127 PRINCIPAL Edith May RICHTER Garibaldi, Oregon Mother 9. BENEFICIARY FOR GRATUITY PAY IN EVENT THERE IS NO SURVIVING Rt. 6, Box 756 SPOUS~ OR ELIGIBLE CHILD CONTINGENT Darrel Edwin NEWHOUSE Tacoma~ Washington Brother SHARE s Not Applicable. NSLI 10. BENEFICIARY FOR PRIN- 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 3581 SE Grant Court SHARE II. BENEFICIARY

원문 (English) 펼치기
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11. BENEFICIARY OR BENEFICIARIES 100 % Norma Isobel Newhouse Same as #8 Wife
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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. Ifatep 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
a
21. SIGNATURE OF WITNESS 22.~SIGDNESIAGNATTOUR R•E O. F
7/l
~.J~
r.AA~uc_,• - ------
- "'MJ ' -.~....
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
c.
To: • , CHPHOl' \:l-4 Delbert UEWHOOSE, USN
Via: Cor:.manding Officer
1
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
MAYG7 1957
Ref: (a) Article B-2206, BuPers Manual
1. This change of addr ess is submitted as authorized in paragraph (2)
of reference (a) .
2. My home of record is changed as follows:
From: c/o Mrs. Vincl Richter
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
2- MAY 1957
FIRST ENDORSEMENI'
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:
,em
BuPers (Per& F24) • ........

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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 subj;d;; ubs~i~;f my clai~reim~burfseomenrt for travel performed by my depend-
t?__--:_t_
MEMBER'S FULL NAME / ~ ---~ - ! ______ ______________/ _Zz~_'F'__J______r;:__~__
7
(First) (Middle) (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-v1'1L-~--~----£k..~__________3/4~Q______ _
------------------------------------------------------------------------------------·----------------·--------------------------------------·------------------------------
*Step children or adopted children must be classified as such. 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
2/1_u~__
were received and departed that place on (Date) __ f ______________ ; and arrived at (Street address, city, and
_3 -/4/6-___
State) 2J~_~_f_J__Tj __ - _" ----- -J---ef~-------, on (Date) G________ ;
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 _____________________
_______________(Pen~/@~ ----------------------------------------- ----- ------------------ ---"
NOTE.-This data sheet 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 Travel"
(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 both."
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
l ) I'
DESIGNATIONS
FIRST NAME-MIDDLE NAME-LAST NA~E ADDRESS RELATIONSHIP
3581 SE Grant Gt.
8. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY Norma Isobel Newhouse Portland 15. Ore. Wife
P.O. Box 127
PRINCIPAL Edith Mav Ri·chter Garibaldi. Ore. Mother
9. BENEFICIARY FOR GRATUITY PAY
IN EVENT THERE IS NO SURVIVING Rt. #6, Box 756
SPOUSE OR ELIGIBLE CHILD
CONTINGENT Darrel Edwin Newhouse Tacoma. Wash. Brother
SHARE
Not Aoolicable
10. BENEFICIARY FOR PRIN­
NS IE TR YV (I C PE LMEeNs," S
B
tI dN D CE oM n-­ CIPAL(S) SHARE
0TtS8) ( All prior dts·
ignationa are canceled.
Designation for in-
SHARE
' de ,nnitr, does not affect -NSLI·· ..,. ·USGLI ·· · · --
. inaitrance (NSLI or 5
;U deS sG igL naI)
ti
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, • •• '.I ·r : • . _! :;' 1 ~ ,~'l r •t :' ; . ;·• ,,j ' :;' c· :· :> J- J, ·, . ~-; \ ,. ·~ ,.. 1,r t;- ~:, ~f :' ,i ;' 1 ..[ ]1 ~: 1- ., !~< ~r ; J., :., -1 -,-1 .~, i lj j; ~ ,·i ;f ·~ ,·:' J·: {~ -. ~·; ~: n, : cI.I : ~.'• t-,· :3· JI if{I:,._.:·.- i~' ·- ·~ ;•! ,~ J) ~," •:: i :"~ !f; ,_,( ?, ' .~l '_!~ ;•; ·t ··~ · ·-Jf~~~:\
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~\•;,•
'·Noah i~ahk' N~\~h~{i;~e''.>L!.i~);~.r:.:l.:;:;_:}/;1,'.·i·\,f,1 ,'.: T~J a:r.J cs·· o + m,· a, , : _ 1,,i,. W J.;. a:l.• s'H h} i;1 n. ~•··• o-a_ n1i'. 1 ;< i· '_ '; :;- -; .· • <1 •,L . -·( ~·, '~ •1 i •i'r ,; .• . • ,1 f : .-r : ;· ,1 ,· ;; -._ :: •; 1; !'(
16, MOTHER: ,,,· <;: ,.: ! •. :: '.·.I '"'''"''•'; :,,,i.:; j•'• ,,,.I,,_·,.: ., f.Jl'
E• ·d,·i•· th1.,:;-~::M·· 1 avj1 •:· R.;if,i c'-,h.·1,t!'fe ,-~r·~· .: ~f! .. 1, ·i .~7/.!;,1,q •.•. q I 1 l~~J,"'.L.
'!''·!,!.'. {') Ji;c,,i",, ;-pr,•: 'lli),'if;:.-:,
17. WIFE OR HUSBAND ( 1/nbnt; .roitiilei ': •. I1.1.;,,'.· '.:!)'; J.••i :~ 1II,:,· ,' • 1•
:: Nrt,t1o; rt i n(j,. a,; ·,-. ·1 ,I,.sobel'.;Ne,whouse n,,.
;.;1,..... : j ·,. ;,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£ 1[).lJ:f~q f ;r,. ~'_.;;c; :r1~:\,;_
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\:tE0 0FlBIR1lt
•• ~:-: f,., ·,- if I,:.,'.' !:; ,·, ,J.! ·:~.i•,·-~. ;:J{~ ;.,.. ~l,_... , .; l-'!1! J_:•, iU lft.iJ} ~ '":fCf ()~ f;)t1J !:~ ~•~-C:~i.h'..i·.. YES· NO
· D D 9 3 -Jt
~ F0 fM For Navy, Marine Corps, and Coast Guard use: Will be used in lieu of DD Form 93.
10 1 55

•
/ RECORD OF EMERGENCY DATA l..;-·1
SEE INSTRUCTIONS ON REVERSE BEFORE MAKIING ENT81ES 14·;~;
I. DESIGNATOR'S LAST NAME-FIRST NAME-MIDDLE NAME 2.. PRESENT SERVIC.E .N O• I S. DATE OF BIRTH
NEWHOUSE. Delbert Clement 17728'3 3~;RATE 6-~-13
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
3581 SE Grant Court
8. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY Norma Isobel NEWHOUSE ~ortland, Oregon Wife
PO Box 127
PRINCIPAL Edith May RICHTER Garibaldi, Oregon Mother
9. BENEFICIARY FOR GRATUITY PAY
IN EVENT THERE IS NO SURVIVING Rt. 6, Box 756
SPOUS~ OR ELIGIBLE CHILD
CONTINGENT Darrel Edwin NEWHOUSE Tacoma~ Washington Brother
SHARE
s Not Applicable. NSLI
10. BENEFICIARY FOR PRIN-
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
3581 SE Grant Court
SHARE
II. BENEFICIARY
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