SECRET (When Filled In)

NAME OF EMPLOYEE (Last-First-Middle) | NAME AND RELATIONSHIP OF DEPENDENT | CLAIM NUMBER
Noel, James A. | Wife: Lillian | 67-0615

There is on file in the Benefits and Counseling Branch, Benefits and Services Division, Office of Personnel, an Official Disability Claim File on the above named employee (or his dependent*) for an illness, injury, or death incurred on 8 August 1966.

This notice should be filed in the employee's Official Personnel Folder as a permanent cross-reference to the Official Disability Claim File.

DATE OF NOTICE | INITIALS OF AUTHORIZING SIGNATURE
2 December 1966 |

NOTICE OF OFFICIAL DISABILITY CLAIM FILE

FORM 1076 SECRET (12-21-65)