Document 1gB3VXedZdmXrogQGram9xj8o
BENEFIT PLANS FILE
1. Claims 2. Health Plan Documents 3. Life Insurance Documents 4. Savings Plan Documents 5. Bonds
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059257
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059258
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Blue Crgs* Blue Sh^d-
;f Te^as 901 SOUTH CENTPAi. cX^f'CSSWAV RICHARDSON. TX 7^030
IMPORTANT
E.TUHN Blue COPY >- Tins NOTiOi
,,17H IHB APOROPK'A't UlOV-K - Hf k l.;?
AS RtOue'MEO BE'-GW URlO'NA'- .0 be.
RETAINED POH -'OUR flubS
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-- NOTICE OF ATTAINMENT OF AGE 65 --
NIUH CARBIDE COKP^SOUVENTS . NTfcRHEOIATES C^IV--TEXAS CITY icXAS CITY TEXAS 775*1
_ BECOME `if, US_______
,,s0 1943>2
JUN 1983^ p-=Er*ED .
0002.
00
KINGSBURY T
TrPi OF CHANGE
DEPENDENT - AGE 65
UTN DORUTHY HEYEN
2/28/1983 36____057 101558101
CODf *
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j memoer ana or spouse will attain age 65 as .zc-.K- iVi'I you please contact the member and
.. wnich of the loliowmg options will be selected.
["nsic; to direct pay and be dropped from i. ,i cOv'--.-' 5.
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STCS Major Medical with con-
'uo'd .-o. billing. Please submit an STCS
application card with the blue copy of this J notice.
3. Remain on group with regular benefits!. *See
Reverse
1
If option t is selected. Slue Cross and Slue Shield of Texas, upon receipt of such notification, wni send infor
mation explaining optional direct pay coverages.
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PRIVILEGED AND "CONFIDENTIAL MATERIAL SUBJECT TO PROTECTIVE
ORDER"
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059260
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Savings Plan General Savings Fund Distribution
51$ 02536 1202
T P KINGSBURY 2905 HOUSTON DR LA MARQUE 77568
personal
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UC 134-43C
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i UCC 8AVING8 PLAN FOR EMPLOYEES
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CHANGE IN NAME X | CHANGE IN BENEFICIARY ARRANGEM ENT
i i 234-24-9903
515
02536
ir | ind |
T P KINGSBURY
_____L_____ l_________
%
i AO1 M IRtty OtQUItT THE FOULOWINQ CHANai(l| lUPIMCOINd ALL PHIVIOU* DCfIONATIONS BE UADI
FOLLOWS;
1t
oca NAMl
m 1 X CHANGE MV BENS Ft Cl ARY DESIGNATIONS TO THE FOLLOWING: 1 L FRI MARV BENEFICI A RY(ICS)
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Thelma 0, Kingsbury
Wife
M AMI
NSLATlONflMIP
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NAMl
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ASK ||P UNOiP Bit
ASI ||P UKBBP >l| | |AOS IP UNO.n it
y IN IQUAL SHARKS, OR TO THK SURVIVORS IN EQUAL. SHARES, OR TO THE SURVIVOR.
UPON SCAT H ASIF SUCH BKNKFtCIARY|lES| IS NOT LIVINC WHIN DISTRIBUTION OF MV ACCOUNT IS MADE
MV
. 1 DESIGNATE
2. CONTINGENT BENEFICI ARV<ICS| NAM
MkATIQNlMI*
(IPAOS
UNO** l|
Marv Suzanne Rodie
KAMI
i Gary Kingsbury
Daughter
MlATlON BM1
Son
AO.
VNOSJP 11 |
NAMl
i
JoLvnn Kinasburv
Daughter
UAOS ||P PI OS A Bt|
IN EQUAL SHARKS. OR TO THE SURVIVORS IN IQUAL SHARES OR TO THE SURVIVOR - IN THE EVENT THK FRlMARV AND CONTINGENT BENEFICIARIES. IF AN V. DO NOT SURVIVE ME. THE ROCEEOS OF MV
ACCOUNT SHALL BK FA VAILS TO MV UEOAL. REFRESENTATIVE AT MV OEATH.
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DATA
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SIDE I r
HIRE - EMPLOYMENT - PFRMANENT
1. Kardex 2. Application or Qualification Record 3. Resume and Cover Letter A. Birth Certificate or Proof of Age 5. Immigration Papers 6. Military Papers 7. Seniority Tie-Breaker Papers 8. Vested Documents
PRIVILEGED and "CONFIDENTIAL MATERIAL SUBJECT ,TO PROTECTIVE
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059263
SIDE II t
TERMINATION - - PERMANENT
CHRONOLOGICAL ORDER
1. 2. 3. A. 5.
6.
7. 4 8,
Off Ticket Termination Request Leave of Absence Exit Interview Property Clearance
TEC Strike Claims
Investigation of Near Loss Time Accident Incident Reports - Accident, Property Damage, Investigation
PRIVILEGED AND "CONFIDENTIAL MATERIAL SUBJECT TO PROTECTIVE
ORDER"
ucc
059264
PRIVILEGED AND "CONFIDENTIAL MATERIAL SUBJECT TO PROTECTIVE
ORDER"
J>*^UNI0N CARBIDE CORPORATION Texas City, Texas
Termination Request
Site*
D`
T 19 66 t \I
W8' IXU&22
Name of Employee^
T. P. KINGSBURY
_TC Payroll No___02536
ego 2-18-53
Birth Date 1-13-23
NY Payroll No
Department PITLS. MGMT.
Classification Stores Clerk
Last Day Worked 2-9-83
Time 3:00-11:00
40H/P.M.
(Indicate if employee was on scheduled vacation on LDW in case of Retirement or Death)
Vacation Eligibility - Current Year:*
Vacation Carry-over from"Pprrlioofor)ITL 7f. fTear*
Vacation Taken this Year: Vacation Due at Terminal
6____ Weeks
0 Weeks 0 Weeks
Weeks
Voluntary Quit* Discharged*
Explain Reason:
Laid Off* Retired*
Disability* T&P Released by Co.* _____
Total and Permanent Disability
0 Duys lUuAA,
Q Days jutf) U^
_Q__ Dalys Q__ Days
9*
Other*
CODE = XM O
Ja^mina^ ed j 8/19/83 gftgfl
te 8/16/83
Present Address 2905 Houston Drive North __ La Marque, TX 77568____
Phone 409/938-1560
Forwarding Address 2905 Houston Drive North La Marque, TX 77568
/*/&
THIS SECTION TO BE COMPLETED BY BENEFITS RECORDS DIVISION
STATUS OF: Savings Plan:
O GF Only-W/D & Cancel (UC134-6D)
O PIA & GF PIA Only (UC134-62) Not Participating
Group Ins/Basic: Cont OCancel OReduce N/P
" " /Supp : OCont OCancel ON/P
Health Insurance: Type Coverage:
Conitt Ol_jcCaanne
N/C Pension Plan: Mature-Full Benefit OEjarly OMature-Reduced Benefit OVested
ONot Eligible
Contributory Retirement Plan: O Mature N/P ORefund Q)Vest
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059265
Pass Returned Cl-1 l to P/R
_____yes ______ no
a.jk3 PST to Sal/Ad
Pull Card for final check made_________
UC134-6D to P/R
UC134-62 to P/R_
Final Check* *includes ' Mailed
if
acatlon hours
"CONS'LEGED AN
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ORDER" Y