APPLICATION FOR RETIREMENT FOR HAROLD FRANCIS SWENSON.
Agency: CIA
Originator: CIA
Document date: 01/01/0000
Document type: PAPER-TEXTUAL DOCUMENT

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104-10131-10006

19U0G

•FIL

:PPLICATION FOR RETIREMENT

To avoid delay-I. Read information carefully; 2. Complete application in full;

3. Typewrite or print in ink

A. PERSONAL INFORMATION

ARAN

SWENSON

Harold

Francis

4. ADDRESS

(Number ond street)

2. DATE OF BIRY

April 28, 1915

(City and State)

144-07-7204

(Zip Code)

CORRES: 5005 *ygemoor Lane, Bethesda, Maryland

20014

American Security and Trust Company, State Dept. Bldg, Wash, D. C.

6. (B) IF "YES." GIVE THE FOLLOWING INFORMATION:

MARRIED!

(Month)

(Doy)

ADDRESS OF SPOUSE IF DIFFERENT FROM ITEM 4

YES

NO

Mildred Chandle? May 10, 1913

Dec 31, 1943

B. CIVILIAN SERVICE

1. OFFICE OF ASSIGNMENT

2. SERVICE DESIGNATION

3. LOCATION OF EMPLOYMENT (City and State)

DDP/EUR

D

Frankfurt, Germany

15-20

4. TITLE OF LAST POSITION

S. DATE OF FINAL SEPARATION (Month) (Day) (Year)

6. APPROXIMATE NUMBER OF YEARS OF

Operationa Officer

May 31, 1968

CIVILIAN SERVICE

20

7. DO YOU HAVE FEDERAL EMPLOYEES GROUP LIFE INSURANCE?

8. AROGRAM ENROLLED IN A PLAN UNDER THE FEDERAL EMPLOYEES HEALTH BENEFITS

EX YES

_ NO

EX YES

O NO

C. MILITARY SERVICE

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

THE COAST AND GEODETIC SURVEY AFTER JUNE 30. 1961.

IF AVAILABLE. ATTACH A COPY OF

YOUR DISCHARGE CERTIFICATE.

BRANCH OF SERVICE

SERIAL NUMBER

U.S. Marine

Corps

035838

DATE OF ENTRANCE

ON ACTIVE DUTY

14 March

1944

ATE OF SEPARATIO

ROM ACTIVE DUT

I January

1946

AST GRAD

OR RANI

Captain

ORGANIZATION AT DISCHARGE

(Div., Regt., Co.. erc.)

Marine Torpedo

Bombing Squadron

232

2. (A) ARE YOU A MILITARY RE

Z. (B) ARE YOU IN RECEIPT OF OR HAVE YOU EVER APPLIED FOR

MILITARY

(RETIRED

CLUDE V.A. PENSION OR

COMPENSATION.)

NOT IN-

2(0) WENT UNDER CHAU RETIRED FRED URESERVE RMERC

NENT UNDER CHAPTER 67.

(FORMERL'

TITLE III, PUBLIC LAW 80-810)?

Retired

IX YES

U NO

YES

NO

YES

U

NO

D. DISABILITY INFORMATION

Only applicants for total disability retirement will

I. WHEN DID YOU BECOME TOTALLY DISABLED!

(Manth, year)

complete Part D.

. BRIEFLY DESCRIBE YOUR DISABLATESS STATE WAFER IN CURRES

ADDITIONAL

COMMENTS OF

CURESAAND HOW THEY INTERFERE WITH PERFORMANCE OF THE DUTIES OF YOUR POSITION. (ATTACH

E. OTHER CLAIM INFORMATION

1. CA) HADER THE WED PAL EMPLOYEES COMAENSATON AFOR COMPENSATION

1. (B) IF "YES," STATE THE NUMBER OF YOUR COMPENSATION CLAIM AND THE

PERIOD FOR WHICH YOU RECEIVED COMPENSATION

CLAIM NUMBER

•YES

IX NO

FROM (Month) (Day) (Year)

TO (Morth) (Doy) (Year)

2. (A) REYE MENT SYSTEM INCLUDIAN APPLICATION UNRET REMENT! SERUNO.

2(8) END SIVE A CEATH TURE ON ARNOON

CLAIM NUMBER(S)

DEPOSIT OR REDEPOSIT, OR VOLUNTARY CONTRIBUTIONS!

& RETIREMENT DX DEPOSIT OR REDEPOSIT

XI YES

O NO

REFUND

SLUNTA

CONTRIBUTIO

3. (A) HAVE YOU PREVIOUSLY FILED ANYAPPLICATION UNDER THE ETA REMINE:

DISABILITY

INCLUDING

T3. (B). IF "YES." INDICATE THE TYPE(S) OF APPLICATION:

FOR RETIREMENT.

REFUND, PURCHASE OF SERVICE CREDIT, OR VOLUNTARY CONTRIBUTIONS?

RETIREMENT

• PURCHASE OF SERVICE CREDIT

• YES

X NO

REFUND

_ VOLUNTARY CONTRIBUTIONS

A. (A) DON TON OR BENET DO COUMAN EM ONES A TREMEN SINE

4. (B) IF "YES." GIVE THE NAME OF THE OTHER RETIREMENT SYSTEM

FBI

Civil Service System

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14-00000

INDICATE, BY, SIGNING YOUG INITIALS IN THE APPROPRIATE BOX BELOW, THE TYPE OF ANNUITY YOU WANT TO RECEIVE. READ THE EXPLANATIONS AND

• CONSIDER THE MATTER CAREFULLY. NO CHANGE WILL BE PERMITTED AFTER AN ANNUITY HAS BEEN GRANTED. IF YOU WANT AN ANNUITY WITH A SUR-

VIVOR BENEFIT, BE SURE TO GIVE THE OTHER INFORMATION CALLED FOR..

F. TYPES OF ANNUITY: MARRIED APPLICANTS ONLY

INITIALS

ANNUITY WITH SURVIVOR BENEFIT TO

WIDOW OR WIDOWER

• If you are married, you will receive this type of annuity unless

you choose the annuity in F. 2

- The annuity payable to you during your lifetime will be reduced

by 2½% of any amount up to $3,600 a year used as the base for

SPECIFY THE PORTION OF YOUR ANNUITY YOU WANT USED AS THE BASE

FOR YOUR WIDOW'S (OR WIDOWER'S) SURVIVOR ANNUITY.

the survivor benefit, plus 10% of any amount over $3.600 so

It you want all your annuity used as the bose for the survivor

benefit, write the word "all' in the box below.

If you want

only port of your annulty used as the base for the survivor

benefit, write the yourly amount of your annuity you want used.

THE SURVIVOR'S ANNUITY WILL BE 55% OF ALL OR WHAT.

EVER PORTION OF YOUR ANNUITY YOU SPECIFY AS THE BASE

FOR HER (OR HIS) BENEFIT.

• If you retire for total disability before age 60 and get a guar-

anteed minimum disability annuity, you may use all or any part

of your

"earned" annuity as the base for the survivor benefit.

You cannot use any extra annuity which may be payable to make

up the guaranteed minimum annuity.

• If your wife (or husband) should die before you, no change in

type of annuity will be permitted, your annuity will not be in-

creased, nor may you name any other person as survivor.

→* The survivor's annuity will begin upon your death and end when

she (or he) dies or remarries.

INITIALS

2. HES

ANNUITY WITHOUT SURVIVOR BENEFIT

→* If you choose this type. your wife (or husband) cannot be paid

a survivor annuity after your death.

(I do not desire my wife (or husband) to receive a

survivor annuity benefit after my death.)

• This type provides annuity payments to you only.

G. TYPES OF ANNUITY: UNMARRIED APPLICANTS ONLY (Including Widowed and Divorced)

INITIALS

ANNUITY WITHOUT SURVIVOR BENEFIT

• If you are not married, you will receive this type of annuity

unless you choose the annuity in G. 2

* This rype provides annuity payments to you only.

2.

INITIALS ANNUITY WITH SURVIVOR BENEFIT TO

NAMED PERSON HAVING AN INSURABLE

AN INSURA LE

INTEREST

SPECIFY THE NAME, RELATIONSHIP AND DATE OF BIRTH OF THE PERSON YOU WISH

TO RECEIVE THE SURVIVOR ANNUITY

NAME OF PERSON (Firse, middle, last)

RELATIONSHIP

DATE OF BIRTH (Ma, day. yr.)

SEE UNMARRIED EMPLOYEES UNDER INFORMATION REGARDING SURVIVOR

ANNUITIES ON THE ATTACHED INFORMATION SHEET FOR EXPLANATION OF REDUC-

TION IN YOUR ANNUITY.

• This type is available to all retiring unmarried employees who ar

n good healt

• Ii provides a reduced annuity to you and a survivor annuity 1o

the person named as having an insurable interest.

* The survivor's annuity will begin upon your death and end when

she (or he) dies.

* The survivor's annuity will be 55% of the reduced annuity you

receive.

• If you choose this type, you will have to undergo a medical

examination which will be arranged by the Director of Personnel

at no cost to you.

* If the person named as having an insurable interest should die-

before you, no change in type of annuity will be permitted, your

annuity will not be increased, nor may you name any other

person as survivor.

H. CERTIFICATION OF APPLICANT

to the fety of my know all e and bolic made in this application are true

WARNING.-Any intentional false statement in this application

or willful misrepresentation relative thereto is a violation of the

law punishable by a fine of not more than $10,000 or imprisonment

of not more than 5 years, or both (18 U.S.C. 1001).

9 November 67 /B/ Harold F. Swenson

ISIGNATURE OF APPLICANT)

1. FOR OFFICE OF PERSONNEL USE ONLY

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