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Insurance Form 816
NUMBER
Revised Nov., 1931
VETERANS ADMINISTRATION
COUNTER RECEIPT-ACKNOWLEDGMENT OF DEPOSIT
Date
Amount of
Amount of
Certificate or
Insurance
Deposit
Policy Number
1-27-33
$
$6450Ca K 798971
Full
Address Insured Name stary D Independence Truman me
of
COUNTERSIGNED
30.60 TRUMANT
for
Rose NARA
Danule G. Idwice
1775
ADMINISTRATOR
JAN 27.1938
This deposit is made on account of insurance premiums and is to be applied sub-
ject to the rules and regulations of the Veterans Administration. A receipt will be
forwarded to the insured if the deposit is accepted; otherwise same will be refunded.
15-306
U. S. GOVERNMENT PRINTING OFFICE: 1931
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"ocrText": "Insurance Form 816\nNUMBER\nRevised Nov., 1931\nVETERANS ADMINISTRATION\nCOUNTER RECEIPT-ACKNOWLEDGMENT OF DEPOSIT\nDate\nAmount of\nAmount of\nCertificate or\nInsurance\nDeposit\nPolicy Number\n1-27-33\n$\n$6450Ca K 798971\nFull\nAddress Insured Name stary D Independence Truman me\nof\nCOUNTERSIGNED\n30.60 TRUMANT\nfor\nRose NARA\nDanule G. Idwice\n1775\nADMINISTRATOR\nJAN 27.1938\nThis deposit is made on account of insurance premiums and is to be applied sub-\nject to the rules and regulations of the Veterans Administration. A receipt will be\nforwarded to the insured if the deposit is accepted; otherwise same will be refunded.\n15-306\nU. S. GOVERNMENT PRINTING OFFICE: 1931"
}