AGENCY CERTIFICATION OF INSURANCE STATUS
Federal Employees Group Life Insurance Program
NAME: HOEL, James A.
DATE OF BIRTH: 19 March 1911
SOCIAL SECURITY ACCOUNT NUMBER: 083-36-2388
CHECK THE REASON FOR TERMINATING INSURANCE:
(a) Separated from service
(b) Transferred to another agency
(c) Employment status changed to one excluded from coverage
(d) Waived insurance by written request
(e) Other (specify):
CHECK APPLICABLE BOX:
(a) CURRENT
(b) NOT CURRENT AT THIS AGENCY
(c) NOT CURRENT AT THIS AGENCY
(d) CURRENT AT THIS AGENCY
DATE: 31 March 1971
SIGNATURE OF AUTHORIZED AGENCY OFFICIAL: Francis C. Moran
TITLE: Insurance Officer, Alternate
AGENCY: Central Intelligence Agency
Washington, D.C. 20505
SEE OTHER SIDE FOR INSTRUCTIONS TO EMPLOYING AGENCY.