Document GmKOjEBbjr10o8mLd79OegxdV

FILE NAME: Keene (KNE) DATE: September 12, 1968 DOC#: KNE007 DOCUMENT DESCRIPTION: 1968 Sept 12 Insurance claim for Henry Carroll ft mutual lift laourooce wmpMjr A E t,; V CLAIM FOR MONTHLY INCOME ACCIDENT AND SICKNESS BENEFITS o cn o ra t fork QBOVP DISUBAltCI BTATPW T F-to-rNu>4 ->V250 Lift Hoary Carroll Bw rf T Operator ( Into boa*, I----------------- V b fr'n * GO-14149 T 1 61 B w T* Dito aftoll tocnM, U ,( m u -- *f Mototblr ! It.Ifato-i.nraa (MM "Km Aaeaat V XaeiMr l tar wftteb E apto ra ft Mtltor. Am . IM U , DM . Ttotof Y -ll Maaik " 12 ! 66 ton-itoftMtalftr Ov Y Ya V a b o 4r a Mtirftr r r * * - * fa la bft wba tkft UakOitr . . -- aatot If "We" * i a a aptaa aato- ................ .................. bfttoMKn tan 1 -* *-------- `-|t t " ^ ~ i -- ~ 1 - - * "-- -- t o tH lM p la a aitata watoar " "* ......................... T i f t f t h - - ` f - f t - r` -n -------'-1-, - 1- - m w 4, raaiwtatotaft fn a u v tb- "<) baaiia V Ikft biaa? If "Ya~ p ia a aptata atodar "Xaaarft " .... ; i TUlftvlA-Bhrot.-Hill. -Ian..----- --- *r------------------ U F L O Y * rf W A Tm PTT I W ~ : ------------ ---------------- ----- g* Henry Carroll *= 3 * U II * * -" * T~ L 1 2 1 h m Brook treat_____________ o ^ BrynMawr-------- S s - -- ? * -- N it u n a f rie k M B o r in ju ry D a te t m In ju ry tn o to d fa r th is d eh o rn s o r ttJ o u tru ? ^ i l / -------- * ........ ...... d f n u y T . ^ y ' '1 .... T ar ------------------------ `f - A / ' - it I f d o t to In ju ry , ft r * d a ta a f I d io t , " BI *-- a s ir Tar I f d a a ta in ju ry , v h o r t a a d b o * d id O ft v t w t d o te v o n y o u f i r * u za b ito t o v o r k bacftM O i o f th is d fc o b fiity ? O b h o t d o ta a r t y o u firrt M a to ra tio n So v o r k f I f t o ta l d faftb iH ty b m o o t s n d e d , w h o a do 70 0 opaci it to and? ..... ....... <7 --t .............. JO ta r --------- Itaft C 6 T ar ' Vw ..... . ... a X u m o o f hoM p hftk o d d a to o a f o a ft* fio o fo e o t fo r th is d e k n a o r in ju ry .t^ o o , -------------- h N om ea so d ed d reeeer o f a ll p h y d eM in e o o e u lte d fo r th fc d e k o e a o r in ju ry f, # J L g o y fim t iL M ijiM A L H im , i . r a - W t o h M t a i M i f I f t M M M i t a f t Stato e t a o rla r mot M a y a - i t a d ia ta lftir r parted - .to-- a t ' . . . - ----------- Y a Ha B a f t s m W ftfaw F ta i ! K A a y 8m m . FbewtarMl a r r - T .T T r ..,, - " t is s s r c js : .* , B B . > " B B If rato m i n n i n i < Nam * af m u m M t o frwa r - ft*bto-fMVI". P*aa toftkKtaBtotoitoftptontauta: i Amviiit of i j KffBio 1 Ho na?ot4 tnm. aix. m'f tv, otcj ^/M/aarVarl' . In . . . . A (to Ad a to . KdIM # IOUSM Amami <f ! Mow |*rM( (La Hrwmu I Wk.r B 'tolr.