Document O1RvmDMa42k16G22VEYON09Gv

FILE NAME: Insulators Workers' Comp Claims (IWC) DATE: 1958 DOC#: IWC023 DOCUMENT DESCRIPTION: Claimant - Reed, Clarence BALTIMORE , NEW YORK i CLARKSBURG / TULSA | j` ST. LOUIS ' CHICAGO LOS ANGELES? ATLANTA PITTSBURGH SAN ERANCISCO NEW ORLEANS MIAMI PHILADELPHIA A L E X K E M Sk A lL IE X T V ID IE IR . INCORPORATED INSURANCE AVERAGE ADJUSTERS CONSULTING ACTUARIES 2225 NORTH C H A R L E S S T R E E T , B AL T I MORE 18, MD. June 7, 1960. Hr. William L. Hughes, Manager Insurance Department Armstrong Cork Company Lancaster, Pennsylvania Dear Sir: Travelers Policy No. rttb-6220500 Please note disposition made of the following claim: Date of Accident: August, 1957 Claimant: Clarence H. Reed Location: San Antonio, Texas Claim No. : B-8742139 Disposition: $500.00 Fatal $1052.23 Expense Remarks: Very truly yours, cm. ALEXANDER & ALEXANDER, INC. Indicate Whether: Workmen's Comp.____ X _ Auto Liability B.I.___ P.D.___ General Liability B.I. P.D. LOSS DEPARTMENT TELEPHONE TUXEDO 9-A304 BELL SYSTEM TELETYPE BA 582 CABLE ADDRESS "ALEXBLUE" BALTIMORE NEW YORK CLARKSBURG TULSA ST. LOUIS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA ; A le x a n d e r & A j l ie x a t o id ie ir INCORPORATED INSURANCE average adjusters c o n s u lt in g actuaries 2 2 2 5 NORT H C H A R L E S S T R E E T , BAL T I MO RE 18, MD. February 19th, 1960 ( C l - -* TELEPHONE TUXEDO 9<4304 BELL SYSTEM TELETYPE BA 582 CABLE ADDRESS "ALEXBLUE" V Hr. R. C. Schiedt, Jr. Insurance Department Armstrong Cork Company Lancaster, Pennsylvania Dear Mr. Schiedt: B 8742139 re* Clarence H. Reed D/L August, 1 9 5 7 ^ ^ Workmen's Compensation, We recently inquired of the Travelers Insurance Company in respect ^ their hich vill S. found . I f explanatory. Sincerely ALEXANDER & ALEXANDER, INC. LOSS DEPARTMENT R I Q83uu v AV^ii - of' ClirencT'H.' Re^.;jTi^r#^.art ;lsotother defeDd1^?, i, tM*. "being the Iw arsnce W J^nsstdon ca rrie rs of 'other 'M\ "Sf ''the deceaeed, aartswelH.;: `Heed. . The,!^dece*sedvworked fear . 2 eossulei 'sub'sequient ;to^Varicing for... TexMi Compensation i c t p w i d ^ t o i t ; `l b ^ i:^ce'MerT-.ftf'.j*i W'^sfe^tj^^*nj,eetiM^^f9r ;t ^ rf ^ V s ^ n t ,of , ; v^'i*.- , f4rL * "' . ` ' " _: 2: ^'1'' J 'a. *' k *W1 am 4 VsT A a 41. M 1)1FV 'V . .'' - .- nay f 4nd th atv e-g o u ld be the- la s t c a r r ie r , ft&yj-}'* Kj'f'Sy^ : :" " . , i : , rb > ' 3 k . b en ^ c l j l l y > . t t o t ^ 2 > i d ^ < ,f .r r t r T , lS i ? , B i I- be trie * a t that - :v ;:/: i : W v ` :.--iv5M>rv : ^ s : ? ^ r V i --:".:;.- if, .*;. ' -v' estdisates aro se t up for $12600 fo r f a ta lity , $1000 rad ical $tA eiai 1250. for jexpeoae. ' " '***'*' '" ' '" **"'" '"*"r ''"' *'** "" " ' PleasV adrise :if you ^desire a n W; , v'/;.;T*1 i ; : y -;y.*: ;,;;.` - Very, truly yonrr, BiHircw SqperTisi HOMS OFflCEi 700 M A IN STfcEiT. 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' / ` ',.' f* `\^p.^ , " ; 1.. ?*i.'- ' ~ ?.- i Ir^ '-.V v r'A - v. *-* ''S' _vs.. ,' *-' ' ^ j. . ./*/ ; ,* 'T <'-- _* Vfr >. v -v,- 1 . * s, : it r i - t--s :-i i-ir > ', -. f J F ,\ . 7 C ^ r ' : ' T 7 7 7 7 . - 7 V A .;. a? : X X ' V : / ; , .\X v ` ^ ' , ^ .t~Vi.X-' ^ ' * v- X. >*' ' i-" .! -^<s~11 * * Hi 7 :; ; v , X ' <...? - : -'_.-X' K s.'/> >i-. *?:* v ...Jv'*-,?- --'"A-.''-A-'i*.C.V-, -A-' - ^ v 'i * -J... :v - '^ .,%>V'- ? 2? ^ . . s ' - V 4 j I' Sa' -.1 In t b A t'to'^iur ^Juijr'i 1959 reqocet tor.'ir* . Xboor of our Joa* 30 leUsr.hick reflects the late Mr*. Reed's llfetia ~ . employnent vitJx Arastrong. Coric Componyr The original yage request e m r n j. ^ ^ X,. froa your Saa Aatonlo office*; end ia ell probability* P^. la atA.eSs'ta! +i,tte__r_'' passed'e. &cAh;aotheaWr^. MoMn 4t"Vho1.yXtU5nrtfl 'S *, ; A ' ' -r.-i*' '` a^* < T ' '' y iZ g u ? . y s s ~ . .; ; X 7; ' ' o u r r e c o r d s i n d i o a t e M s t ^ n a i n a t io n v a s d u e t o . l a d e o f _ w . ? S in c e -. ;;... ? : - d id o t re p o rt^ a a ^ x r illS h i s e n j^ L o y a m t, we# o r ,c u rs e ^ n M ^ n o ^ ^ ; XvA.jy '\ x? ;.X-'X reason *to subnit'an ^jioyer*s J ^ r M . Report L; :* -7A..r:. ./u 'P e k i n g hMis ffoouurr.^vveeSeciss ooff'^ea'pelaoyMaoeTnOt^vVivthi ^'ltioastlx^ongg,^ ye did find ; -XV; 7; X-th^t the group he'voriced vith ordinarily pat in a fire day y ee^* * - - 7;X.:'V " "aignificaat that alght be, .ve btamotfsay*.- Perhaps, soaeone in^the Dallas. ` ' office of Arastrona Contracting' and Supply. Corporation aight nave the - ' " ' ^ ,,saswers. 'V'";'.". 7 ' ; A -V > -X. - - -t. '* .. _ , _v - ? . . .*,5. *r, * \ cjfc ^- _SP'" ~' 7'yei^r! t u y 'yours,' ' -.i 2J; * 7/:^v~'v % V7-:^ ^ ^ 7 ':^ x i ;-;';'!>f ;a -.-,*-AAi..,' "JEX 7 . Ba d o sure AHMSTROaa COiX COMPART v-i-^ V' : 7 ^ ^ ^ '-`.*`v` 1* * 'Xi S. C. Sdiiedt, Jr.^' x 'At; ^.7.XX,.; j.* InSur&nee Departnesat;-;;'.X;7;^ 'A .XX X - 5 E. J . S te m , AC&S, D a lla s '7 7 ; j , E . .Z e l l e r , AC&S, L an c aster.; ..'3 W AOC OlAICMtiSI O `-EM PLOYEE t l ARCKCf M a s * W i l m a L s t h c s K l e 5 \ %o c m ^ . DATE Noricn MAIL!!!) CLAIMANT DATE OF HEARING BOARD NUMBER O MR oims oc *r t , r s1A2f3i OK R3e o*a W SB t Jr-e eRtR Y W A V M E R e t o , 1 - 3 - 5 3 7 - 2 3 - 3 9 s 6 0 U 7 3 S am Amtomo, Te x a s INSURANCE CO. NO. O O Mn Ru dt Rc*> A ttormct h \ 7 S outh Mai m S am Amtohio 5* Te x a s O EMPvusoYER/BM8TR0>i8 OMK C OHPA H T .';! w \'X'> 'T? VWw $ " avn- INDUSTRIAL ACCIDENT BOARD WALTON BUILDING AUSTIN 14, TEXAS Claim for compensation from the employee named at left will be heard on "Date of Hearing" shown above. Below are requests for Employer's First Report of Injury and wage information. Only those checked are being requested. O / 52^ H. In d u s t r i a l S l v d . D a l l a s ,/Te x a s 77 O in s u r a n c e , ^ carrier .jHt t r a v e l e r s I k s u r a h c e Cqmfamv 710 S c a s b w o u c m Btca. O. Au s t ih , Texas CC: Mr . J ames Be r c e W H EN W R IT IN G TO TH E BOARD CONCERNING T H IS CLAIM ALWAYS GIVE TH E BOARD'S NUMBER AND STYLE OP THE CASE. DATE OF IN JU R 10-7-57 / ' NATURE OF IN JU RY / COUNTY WHERE IN JU RY OCCURRED SCXA* o P H REQUEST FOR EMPLOYER'S FIRST REPORT OF INJURY o No report of this injury has been received by the Industrial Accident Board. W e call your attention to Section 7, Article 8307, Texas Civil Statutes, requiring every employer carrying Compensation Insurance to keep a record of all injuries sustained by his employees in the course of their employment, and to report same to the Board within 8 days, if the employee loses more than -- 1 day's time from his work on account of the in ju ry: A severe penalty of not exceeding $1,000 is provided for failure to make Q such injury report. You should also furnish a copy of this First Report of Injury to your insurance carrier, if you have not already done so. 3 REQUEST FOR WAGE INFORMATION G On the reverse side is Employer's W age Statement which the Board requires that you complete and return to this office prior O -- to "Date of Hearing" shown above. This information is requested for the 12-month period immediately preceding "Date of Injury" given above. If. this employee has worked for you less than one year, you should submit a summary of wages for an employee of the same class, working substantially the whole of the immediately preceding year in the same or a similar employ ment If you furnish an employee board, lodging, laundry, fuel or other advantages in addition to regular wages, or if the O employee received tips or other gratuities for services, BE SURE TO G IV E THE ESTIMATED VALUE OF THE ITEM OR ITEMS. If you fail to do so, the Board will assign an estimated value. . This statement will benefit you, because it will be used to prevent an excessive compensation rate, and will insure the payment of compensation at the correct rate in this claim. ` o Jt '7% K e, o e x e c u t iv e d ir e c t o r O Return To: i o INDUSTRIAL ACCIDENT BOARD WALTON BUILDING AUSTIN, TEXAS o CAUTION: BE SURE TO COMPLETE REVERSE SIDE OF THIS FORM YV/A\-7l_ O l/AI C W C N I E y p l o y .e e C u A C ) i C 6 f t , | R & * C C C * 6 ` H a . W |1 *A L 5 THCS R t t * V id o * . DATE NOTICE M AILED CLAIM ANT DATE OF H E A R IN G BOARD NUMB C l % Roscbt Fa * * AM* J t a a T Wa t h c R U o , M iH o at* 12 3 0 C s s t * S t a c t t -3-59 7-23-59 $ &&73 Sau A h o m o i Te*** 9 IN SU R A N C E CO. NO. INDUSTRIAL ACCIDENT BOARD WALTON BUILDING O Hi* Ru? Rt*# ATTOCT H IT SOUTH H a i * S ai A n t o n i o J, Tt*A* AUSTIN U , TEXAS . Claim for compensation from the employee named at left will be heard on "Date^of^ Hearing" shown above. Below e VS EM PLOYER A n s t n o n o C o * G****1* 0 1 2H N. IND U 9T IAt Btvo. D a l l a * T c x a i ^ane^'requests for Employer's First Report of Injury and wage information. Only those 4 $ '^ ' '<-cc'h^e`c`k'*e'd are `bei'ng requested`. #5 9 INSURANCE C A RR IER t u t TiAVCi(NO lNSUNANCC COKfANT " 10 S ca * 8 oucm B u c a . 0 u s n * T*A* CC: M i * JA H O StNOCN 9 DATE OF IN JU R ^ * " NATURE 0 7 IN JU RY 10-7-57 W H EN W R IT IN G TO T H E BOARD CONCERNING T H IS CLAIM ALWAYS GIV E T H E B O ARD'S NUM BER AND STYLE O F TH E CASE. COUNTY WHERE IN JU RY OCCURRED @CXAft f^fRREECQUEST FOR EMPLOYER'S FIRST REPORT OF INJURY ^ No report of this injury has been received by the Industrial Accident Board. W e call your attention to Section 7, Article 8307, Cp Texas Civil Statutes, requiring every employer carrying Compensation Insurance to keep a record of all injuries sustained by his employees in the course of their employment, and to report same to the Board within 8 days, if the employee loses more than -- 1 day's time from his work on account of the injury^A severe penalty of not exceeding $1,000 is provided for failure to make 0 such injury report. You should also furnish a c o p / o f this First Report of Injury to your insurance carrier, if you have not already done so. REQUEST FOR WAGE INFORMATION On the reverse side is Employer's W ag e Statement which the Board requires that you complete and return to this office prior * to "Date of Hearing" shown above. This information is requested for the 12-month period immediately preceding "Date of In ju r/' given above. If this employee has worked for you less than one year, you should submit a summary of wages for an employee of the sama class, working substantially the whole of the immediately preceding year inthe same or a similar employ ment If you furnish an employee board, lodging, laundry, fuel or other advantages in addition to regular wages, or if the 0 employee received tips or other gratuities for services, BE SURE TO G IVE THE ESTIMATED VALUE OF THE ITEM OR ITEMS. If you fail to do so, the Board will assign an estimated value. 8 ' 9 This statement will benefit you, because it w ill be used to prevent an excessive compensation rate, and will insure the payment of compensation at the correct rate in this claim. 9 EX ECU TIV E O IRECTO R Return To: INDUSTRIAL ACCIDENT BOARD 9 WALTON BUILDING AUSTIN, TEXAS 9 CAUTION: BE SURE TO COMPLETE REVERSE SIDE OF THIS FORM 1 1-* k w *- t.n n i r n n t --r t in k . I r \ K I C m O V T O D O A D h AIR MAIL -V;; In connection with the subject claim, please find Wate Statement received today from the Industrial Accident Board at Austin, Texas. You will note that the date of hearing is 7-28-59, therefore,; all papers ,in .connection .. . withTEis case must'.'te processblTas soon as possible. _ " ' Enclosure < ' - H. T. Hiller, San Antonio . Juna 30, 1959 She Travelers Insurance Company 201 H. St, M 7 * Street Saa totcmia 5, taxas Gentleaen* Attentions Mr. H. W. Hill 1 / i V.' Subjects Cl&renoe H* Heed V Claia #8-8742139 The following figures indicate the entire (jojt Ccsapany of Glareooe B, Bead, 8*8, #216-10--7857. Texafl ^ Armstrong far S3ding 8/25/57 9/1/W 9A5/57 9/22/57 Wages $ 77.28 77.28 77.28 ThM Days 3 3 3 J! Hours 24 24 24 $309*12 12 9$ During th. d w plojHmt, v. did not M t a l t en nooldt report, m i our records indicate both tarainationa vara dae to lad; of v o w . Vary truly yours, ABMSTRQHG 001 OOHPAHI R, C. Schiedt, Jr, Insurance Department JE 2 E* J. Stern, AC&S, Dallas J. E. Zeller, AC&S, Lancaster i _______'- i -- *- PV.*-^ 'vxc^v-'^ S -S ? ?-/-s7 ? -!S S ? K^tJu> ju Q L O o ,y ^ / ?7<r I 1a8 ! ! \ 77 ^ ^ ? / ~/> ? S s ? v -r 5 : 1. : i " : 3 7?<2<f' f 3 0 9; 7A idC INTERj 'OFFICE C O M M U N I C A T ! O N To From Subject J. E. Zeller, Lancaster E. J. Stern, Dallas Claim for Compensation for Death Clarence H. Reed Social Security #216-10-7857 (S fm stro n g AIR MAIL On June 19, we wrote to you with reference to the above claim. Attached please find letter from The Travelers requesting further information in this regard. We have checked our records again and herewith is a tabulation of our records of his employment: Week of 1957 8/19-8/25 8/26-9/1 9/9-9/15 9/16-9/22 Dates Worked 21 22 23 26 27 28 11 12 13 16 17 18 Total Hours 24 24 24 24 Rate $ 3.22 3.22 3.22 3.22 Gross $ 77.28 77.28 77.28 77.28 You will find copy of Employer's Wage Statement enclosed and no doubt, you will want to check your Lancaster records before completing the Statement. We-have searched our files and cannot find that a First Report of Injury was ever reported to us or filed with the Industrial Accident Board in Austin, Texas. Please advise us of anything further that we can do in this connection. H. T. Miller, San Antonio CLAIM DEPARTMENT PAUL W . BOGUSCH, Claim M a n a g June 22, BRANCH OFFICE ^ .fP e tro lcu m Commerce Building 201 North St. Mary's Street ^ .vv; b ^ l ' VrC v^ 5. C SAN ANT0NI 5<TEXAS Telephone: CApitol 5-7661 Armstrong Cork Company Plantation Roach Dallas, Texas B-87i;2139 Armstrong Cork Company Re: Clarnce H. Reed D/L: 8 - 5 7 B-87l|2076 B & B Supply Company Re: Clarence H. Reed D/L: 5-1-59 Gentlemen: We have been advised of a claim for compensation of beneficiaries of Clarence H. Reed through their attorney, Mr. Rudy Ride, of San Antonio, Texas. Such claim is for death benefits under Workmen's Compensation A.ct, death caused by asbestosis. The claimant allegedly worked for you during the months of August and September, 1957, in San Antonio, Texas, at the jobsite of the National Bank of Commerce `Building. ,It is alleged that Clarence H. Reed breathed asbestos dust and became infected with asbestosis and subsequently died on December 29, 1958. Would you please forward to us the employment dates of Clarence H. Reed and also forward a first report of injury - compensation, if Clarence H. Reed ever advised you of such an injury. ' We are also forwarding for your attention Employer's Wage Statement for completion for the weekly wages of Clarence H. Reed for the period of time that he was employed by you. VJe would appreciate a prompt reply to this letter as we anticipate ,?n early hearing before The Industrial Accident Board and the possibility of suit being filed if such claim is denied by The Industrial Accident Board. Thank you for your attention in this matter. Very truly yours, HWH:rcw HOME OFFICE: 700 MAIN STREET, HARTFORD .a g e a ig i^ ^ ^ N d a im ifrsagsttBB^ ^ EMPLOYER^, wage statement NOTE: PRleetuasrne coormigpilneatle ttohisthSistatoefmfeicnet ipnromdpettlayi.l in duplicate. . A Send duplicate to your insurance carrier. INDUSTRIAL ACCIDENT BOAR AUSTIN, TEXAS DAYS WORKED HOURS WORKED Shnw number of days forked and amount QQiHCU < OAJWt " IJs i c worked. STATEMENT OF TOTAL EARNINGS OF FROM PERIOD COVERED BY EACH PAYMENT FROM TO " MONTH 1 DAY MONTH DAY 2 3 4 5 6 OCCUPATION WAGE RATE (By Hour. (Type of Work) Day, ft'eei, or Months AMOUNT EARNED 7 TO 8 9 1. STATE MAXIMUM NUMBER OF HOURS 10 WHICH EMPLOYEE WAS PERMITTED TO WORK PER WEEK OR MONTH UNDER THE 11 PROVISIONS OF ANY STATIJ T E . REGULA- 12 TION OR AGREEMENT LIM I T 1NG HOURS OF WORK. 13 HOURS PER UNO ER 1 4 <' ' A 15 16 2 . HOW MANY DAYS CONSTITUTED A WEEK'S WORK? 17 18 . t 19 3. HOW MANY HOURS CONSTITUTED A DAY' S 20 WORK? 21 22 4. IF EMPLOYEE WAS FURNISHED BOARD. 23 LODGING. LAUNDRY. FUEL. OR OTHER AD 24 VANTAGES HAVING A VALUE WHICH CAN BE ESTIMATED IN MONEY (excluding, how 25 ever, any sum paid to employee to 26 cover any special expenses entailed on him by acts of his employment). 27 STATE ESTIMATED VALUE PER MONTH OF 28 EACH ITEM FURNISHED. 29 1TEM FURNISHED ESTIMATED VALUE 30 < 31 32 ITEM FURNISHED ESTIMATED VALUE 33 $ 34 35 36 1 CERTIFY THAT THIS STATEMENT 37 IS TRUE AND CORRECT 38 39 DATE 40 41 42 CITY STATE 43 4 44 45 SIGNATURE 46 47 48 O FFICIAL CAPACITY 49 50 51 EMPLOYER 52 TOTAL DAYS WORKED TOTAL AMOUNT. EARNED  . I BALTIMORE NEW YORK CLARKSBURG TULSA ST. LO U IS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA A lex a n h er & A lex a n d er IN C O R P O R A T E D INSURANCE AVERAGE ADJUSTERS CONSULTING ACTUARIES 2 2 2 5 NORTH C H A R L E S S T R E E T , B AL TI MO R E 18, MD. June 25, 1959 TELEPHONE TUXEDO 9-4304 BELL SYSTEM TELETYPE BA 562 CABLE ADDRESS "ALEXBLUE" Mr. Wallace B. Hofferth, Asst. Insurance Department / Armstrong Cork Company / Lancaster, Pennsylvania General Manager Re: CLAIM FOR COMPENSATION FOR DEATH \^31arence H. Reed _____ Social Security #216-10-7857 Dear Wally: Thank you for your letter of June 24th and enclosures. We note that the Attorney has forwarded a copy of his letter with a copy of the claim to the Travelers Office in San Antonio, Texas. We are sending the original of the Attorney's letter and a copy of the claim to the Baltimore Branch with the request that they follow through and advise us of the developments together with any reserves set up for this him. Yours verv^triiTy, ALEXANDE 8f ALEXANDER, INC. JEF/be J. E. Fannon Vi^e President - Casualty --.- J" TZ' - June 24, 1959 ^.T a.''.4~'v^` * ^r --4.-' J* -r "' <- Hr* tea *?" .;* v /; y Alexander A l e x a n d e r , - X h e ^ i / ^ V ' - T- 2225 .v 'Charles v^?: . - - : V . ' v - vyVfeA .; ' '* a.-- *v? :v ' w a o t w w o w w . . - /- v** . 4' 'r--v -^V`- ..'Social Security r ^. '.y . { #r j ^ - : <^-V: :: E n i o s e i are a letter fro the law officee of ^ty.Riee, . San Antonio 5. Texas' id a Claim for Compensation for Death in behalf - ` of the widow, Kre.~Wilaa Esther Heed, . 1 2 ^ Essex. Street, ;:.. Texas.-' - "' '-'' * <w - - -- - -- -- --- -------- Clormo. B. Rsadvas ployed In our Oontrnot Operation,, darin* a . folio*- lag periods! . % 8/25/57 to 8/ 28/57 r Quit Voluntarily, ,t ^ 'r- . 'A" '9A 0/ 57jto 9/18/57 r Quit Voluntarily ? `--V- ? :'"Please forward one copy, of the'enclosed aateiial 5er offic- f ; The travelers so that our' Interests aay be , ^ y protocted^. fy . y y , r - , . -"- ' r ` JSincerely yours, je t Enclosures^ Wallace B. Sofferth Assistant General Manager Insurance Department INTER, ^ ' 'OFFICE C O M M U N I C A T I O N To From Subject J. E . Zeller, Lancaster E . J. Stern, Dallas UN 2 3 i m WLH Claim for Compensation for Death Clarence H. Reed Social Security #216-10-7857 June 19, 1959 / / / / Please find attached letter and Claim for Compensation for Death from the law office of Mr, Rudy Rice, Our record of employment on this man is as follows: Hired Terminated 8/25/57 9/10/57 8/28/57 9/18/57 Reason Terminated Quit Voluntarily Quit Voluntarily Please see that this claim is given to the proper authorities and taken care of as soon as possible, MO Enclosures H. T. Miller, Jr., San Antonio LA C .* T l j cSir ny v7 - ' e^Piortiur Claim for Compensation for Death IN D U S T R IA L A C C ID E N T B O A R D _ , A U S T IN , T E X A S .................... V fv r a - -- T h l. cUlm b o u lib * mad* o a t In d a pi! eat*; on* copy th ereo f shoal* b* mall** to lb* Indu* tria l Aeoldat Beard and tb* e ^ I ? W . h 0uW bo * l l T ^ U th . E m ploy*? o r t h . ln .u r a n c . Company or A**ocjaUoa <=ry`* ^ l**urae. -, ' ' T h ia in to n o t if y y o n A s s s i t r o o * :' 7. - * v r ' ^ r T T S w T r E m p l o y * 0* M M claUoa o r com pany w ith w h U b o m p to y ' ir*4L ,, ^ th at I claim compen^tion from you E to p lo y e^ of T a a on awount p i ^ e death of L C L m n c s -JL -K ftA Namo of d*c*a*od mployo*. ww mhicfhl ri nesuunltceud fi:sw m _I_',,r _on th e 2 9 t h __ day of. -- rffS*C Gn vBr~ e lwSS..., . .while in the em ^ oy .`V. <y- ,A-J?L?^'-!,t*?*':x _ Kam* or*m ptoy*K ;% -tV-.'s-` . ,w <**w i 9n* .* -i; i#*. * _ " , W1B *i t o i ,,Yo. t ^.y _ _ ..,TM. . _v ~r , a. .. . i i...* ' o M_i.^/ <j ut u* tneu nM oBr dBesBcritpttio. n^ of b u d d ie s or plaea. v .*,. . - ' ' " ' ` ................... ' ' " .*7 'f- ' .-'''O' v - ' V i , V "- '" f-W ` ' ' **- girt ....... ,. . ;r .Ihe'cause* of $ % , ? - -jM * e S t Name and P. 0 , address of A ln esses in support of claim: { H r ffi* V l l n a S f g t ? y # t :y g^in A s i t e m if t a- T e x a i ^ ^? AA^V. Give names and P ^ o i hddreM of the Beneficiakes of Die deceased" {stating ^ e Wnshlp of each such Benefi. clary"to f t . dcceucd) :. M r . . f t c a fc K * * d , .K M . . H *& Q Sze?- _ . .................................................................... . ^Which of the legal Beneficiaries above named are minors? . R o S ^ r t f r < 2 a k % & *& ' S ^ State agesh^T n-D ^Sw --IX p--1 $ A3y~& ^~**6T .- .-v ,. - * d t s r l a ^ ; . ; . r . " ^ - . - / . Wages of deceased employee on date of injury were S sjc" ><*- J l f i l i T . . . - . - ... . r ..-, . ....... . . . .. - Day, wk or month. - -. . . ;. Ji^ r i : 5 , v #' ; s ^ ;v ''y 5-' - ' ` ' ' Deceased was employed ~ week. ; V y -, *. 3otuasta*v wwha.stwh oiwr i* * t d--ayv*. .- _ .*-- * . ,* >-* " * ^' ' *' . - - ' t This H*lm for compensation, w ith respect to such injury and because of the death of deceased, is made hi b r i r i f f f 2 d & S d a n of the legal Beneficiariesi <rf Die deceased, as weD as by and for the under s i g n e d , h e herein acting for himself and such legal Beneficiaries. . . *> ' .- ^Social Security No. - of Deceased--2-X^2.w-**7c37------ . day of-- .-- Stynatur* of Claimant. -.__JL23iLJEajis^Jattat-L . S tr* t an d n u m b ar. & tn a t o n io . T e x a s ' City or town. i9 _ ^ a 4 BALTIMORE NEW YORK CLARKSBURG TULSA ST. LO UIS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA A l e x a n d e r & i x a w u d ie ir , INCORPORATED d INSURANCE / AVERAGE ADJUSTERS CONSULTING ACTUARIES 2 2 2 5 NORTH C H A R L E S S T R E E T , B AL T I MO R E 18, MD. June 7, 1960. Mr. William L. Hughes, Manager Insurance Department Armstrong Cork Company Lancaster, Pennsylvania Travelers Policy No. R T T B - 6 2 2 0 S 0 n Dear Sir: Please note disposition made of the following claim: Date of Accident: Claimant: August, 1957 Clarence H. Reed Location: San Antonio, Texas Claim No. : B-8742139 Disposition: $500.00 Fatal $1052.23 Expense Remarks: cm. Indicate Whether: Workmen's Comp.____ X Auto Liability B.I.___ P.D.___ General Liability B.I. P.D. Very truly yours, ALEXANDER & ALEXANDER, INC. 1 TELEPHONE TUXEDO 9-4304 BELL SYSTEM TELETYPE BA 582 CABLE ADDRESS "ALEXBLUE" BALTIMORE N&W YORK CLARKSBURG TULSA ST. LOUIS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA A le x a n d e r & a x j e x a t o b m s ir INCORPORATED INSURANCE average adjusters co n su ltin g actuaries 2225 NORTH CHARLES STREET, BALTIMORE 18, MD. February 19th, 1960 TELEPHONE TUXEDO 9-A30A BELL SYSTEM TELETYPE BA 582 CABLE ADDRESS "ALEXBLUE" I Mr. R. C. Schiedt, Jr. Insurance Department Armstrong Cork Company Lancaster, Pennsylvania Dear Mr. Schiedt: B 8742139 , r e : C la r e n c e H - R e e d ^ D/L August, 1957 T.T,, r v o n H C o m p e n s a t i o n . ,,,, --J ir s s r s ." " . 2 S. i n . . .-< Sincerely "" TM - ALEXANDER & ALEXANDER, INC. LOSS DEPARTMENT V c u m MMSTMOKT ' t u x W. IOOUSCM, Om * o! > V jf J t t r .^ m vc/crt- ntn/r^ t Vv/yW.- * ~ ; S //* y /r& iv A jti .jT td i'm tu fu / fm A * x f ' * -rj ****-: - f. c' !t *' ' '."." f . -- > A .lc'% ' ? [ . LjT-l* ' - j - & -<- fc A N C H /.*p.f;<T*&Cw.**C;. V- '-' y-* " K i- - * .' i , . * ^Iktf9i*a CMdWM - 20! Nortk'&rteffi *fSt;i,!? :a i'*`'`'' - . SAM`AHtOM O ^"advise that the aDcve captioned claim i s ' presently' +u -'" "-'*11 - ,. D is tric t Court, Bexar County,- San Antonio /.Tea*# 1 y d - ^ 1;. p la in tiff' s',,attorney is jilleg in g asbestosis. vnich caiw ad ^ ^ d M ttt^ i: ^ -, -- : of Clarsnc H.' ftead.1 Thera are..also other..defendanta in ,th is s u it , & :) % '*" 'being ''the insuxanca 'conpensatlon ca rrie rs of .other'previous enpisy^f ^ o?;the; deceased, Clarence H.,Reed. 1Tbs,'deceased.worked for two other; .^ ^ ' eWbyMr^onalUn^i^e9s gsuy,bi/s9ev*q^uUAean* vt tyow ww mormking *fo*r JLn&*^sr trorigpy, Cr o rkj C.o. m p any end tha- - f axas C o ^ eo aatio n A ct prorid.es t h a t ' th e l a s t caJ*r,i e r : ,. *1* the^^e~a> r- H= re* rv ^r _ fr or . riilii^illty'Jurrier'.V^iB^a^ai ^'Co^ - be danotsd : . . - -H <e swla vv e .rr *; ;.-.r-:r ; r l'it rit ! oacesaaiy*^^^''to^^^ntain ^an ;, "a. fa ta lity 'c la i* 'since'i t .i s 1conceivable', andT 't \: ; .'/'nay find that ve would be 'tha la s t c a rile r* :v'- v ' ;i '- ? -j-^v rS ;..:j\;--; .' / ) v;-;':^'# : $ ?' V - `l " i - X , " W.'. -'.'i.'- f'- ' \ u\ y i ^ ' . `S J j * ~ r ' . k - W L l ' x v i ''' ***** r i S w a w . - 1C& ? ssid -vi ,.-r. ThS . t o Tbs'.eetiEa'bes'.'sre "set v p for $12600 for fa ta lS ty . >1000 neoical . and $1250 for expense. ........................................................................... , - \ - 7 ,:;: _ _ . ^ '-. ,;v. S ^ ^ p ^ f f y A f Pl^aso cdrlao i f you deaire any further in fo r^ ^ in* - ,, ' -- .* - ^ _ -./ _ * ' '*.. ~' ' .':' h ^. ..., . , r . * ..? -'-F^' y -O^'; V `v ;-'^.:-K v"'. 'V ' v ^ T e r j tru ly youreyfe^t^fepf :{ - V "* (?*V` fyH trssr A . K a r e l # ^ * K ;i, s-fcfM 0< yy J#* '.'' '=?.j!: " ..; V ' ` -:' i - HOM OfFICEi 700" u k i k STMET. H A I T f O t n . - -~ -T-- '- - - ^ .'V'" -1'' ''^ ly-4* y* 'C ` /-Ti , - " ; BJ ; " ; ' J .<t`. v. ` V-'* *'*A -T *'' " k_~ . " V '*>AA-*/*: ' '*(* "* *- -A'*A?A _ *.** 1 .'i. ^ .i jS '* , '! '5'"; -*" ' V 1, ' * A r -?-,, \ : '. / A '- A W- A . " ' -', \ 1 ' , - ? . . }: '- A A A '* ' / s . ^ V , - ' 2 V-'""/'-^yv'rA -'.-A A -i *; . . t ' . " >V** "'r,-'- cV*\ `,.*v. ' `tV* -- \ r " a ' \-f "' , . -- i 1 * ' V;r ^ -, 1 A a 'A' a A-k Al - ;c- - ** .V* - \ A~ A .' a ;; ^ *:V ? .. .-J ? Tfis Tr'ayra insurance *Company y V A <\. 710 Scarborough B u i l ^ S l - ,,I*., .. Austin, Ter -.j A : v \ ' ' July 10,'1959 -A > . * ` ,-Xm --. ,. *&' Subject \Hr, .k _t f c i f c A A y A f e :*A w A . .;:,'; v d e l m ^-58-8774422113399 -- A A A V-: A A A 'A A A - /,\A; - " . M ,~ '- - V i-' ' " * *v 7. ' In reply to your July 3, 1959 request for vage information, ve 'encloee a ^ copy of our June 30 letter vhich reflects the.l&te Mr* Reed* s lifctina eaployaeat with Arastrong Cork Company. The original vega requeat^csae ,.^ froa your Sen Antonio office, and in ell probability, our rejly_end your; latest letter passed each,other on _the. wayA .'- r ^ A 'v.rA ."" A ' A Our records indicate his .teraination was due to ,lack of work. Since he;;^ did not report' an injury daring his employment,'we, of course, had no , reason to submit an Eaployer|.s First Beport of Injury* ; Xn ^ A A n g hia four weeks of eajJLoyaait with Armstrong, we did find ' " that the group he worked with ordinarily put in a five d ^ week. How - significent that might be, .we ceanot aay. P e r h ^ s eoaeone in^the Dallas, office of Armstrong Contracting' end Supply Corporation might have the ' -...; answers. Mr, B. J, Stera, district asnager, w ^ d be^the nan to mtact. A ; A .*1 :'7y 7 c 'A ;- C>.T w y 't n u y yours, A / A - cd eb co m pasi J E 2 ' . ".* -"C ' , - * . >: .*-/* . _ Saclosure . '-7';'' '_- r`_ - ./' : , E. J. Stern, AC&S, Dallas \ J. E. Zeller, AC&S, Lancaster A B. C . Sdiiedt, Jr. / : Insurance Department ' ` A .  t IN TER* jO F F IC E C O M M U N IC A TIO N ' ' To J . . Zeller, Lancaster. ^ _ From E . J. Stern, Dallas ' > ' -* Subject . Claim for Compensation for Death' Clarence H. Reed ' . . - Social Security #216-10-7857 conairio> i July 6,1959 AIR MAIL In connection with the subject claim, please find Wate Statement received today from the Industrial Accident Board at.Austin, Texas. You will note that the date of hearing is 7-28-59, therefore,.all papers.in connection with"tfiis "case must, be processSti*as soon as possible. .. - LB ,. . . \ ' Enclosure H. T. Miller, San Antonio W AU fc b I AT EM EN T O EMpL v ,a t l A R C K C h # - ^ - E ! , cc 'o Mas* Wilma K c e s * Wie- O R oSERT FaAHK A N I R R V VTA t ME K ' - E O , Mi n o r s , 123O s s t * s t r e e t S am A h t q h i o , T e x a s O O MR Ruo* R i C f , ATTORNEY - ..., :: -v a ' 1- lN\r ,-'v " i|1 7 SOUTH MAI `vv K. -ia'- 7v ^" SA Antonio 5* TCXA8 O <5 .' V VS E M P L O,YyeEX? h s t o n E -o s k C o h P-A-HT O _j _ / 2^ N . HOSTRIAL B u t s * OALLAsy Texas 7/ t i * O INSURANCE CARRI ER `The Tr a y c l e r s I nsurance Company 7 IO S c a r b r o u g h B l d g * O Au s t i m , Texas 1>ATK NOUCT MAH,FI) CLAIMANT PA TE OF IF AILING INSURANCE CO NO. 7- 23-59 HOARD NUMBER s &A73 INDUSTRIAL ACCIDENT BOARD WALTON BUILDING AUSTIN 14, TEXAS Claim for compensation from the employee named at left will be heard on "Date of Hearing" shown above. Below are requests for Employer's First Report of Injury and wage information. Only those checked are being requested. CC: O DATE OF IN JT 7^57 M s . JR ^ * J ames Bergen / ' " n a t u r e OP IN JU RY 10 -~ -5 7 / W HEN W R ITIN G TO TH E BOARD CONCERNING T H IS CLAIM ALWAYS GIVE THE BOARD'S NUM BER AND STYLE OP THE CASE. COUNTY WHERE IN JU RY OCCURRED B exar w ~Z p H REQUEST FOR EMPLOYER'S FIRST REPORT OF INJURY No report of this injury has been received by the Industrial Accident Board. We call your attention to Section 7, Article 8307, Texas Civil Statutes, requiring every employer carrying Compensation Insurance to keep a record of all injuries sustained by his employees in the course of their employment, and to report same to the Board within 8 days, if the employee loses more than -- 1 day's time from his work on account of the injury. A severe penalty of not exceeding $1,000 is provided for failure to make 0 such injury report. You should also furnish a copy of this First Report of Injury to your insurance carrier, If you have not already done so. f _ [T J r eq u est fo r w a g e in fo rm atio n On the reverse side is Employer's W age Statement which the Board requires that you complete and return to this office prior _ _ L to "Date of Hearing" shown above. This information is requested for the 12-month period immediately preceding "Date of Injury" given above. If this employee has worked for you less than one year, you should submit a summary of wages for an employee of the same class, working substantially the whole of the immediately preceding year in the same or a similar employ ment. If you furnish an employee board, lodging, laundry, fuel or other advantages in addition to regular ^ 9. J ,he O employee received tips or other gratuities for services, BE SURE TO G IVE THE ESTIMATED VALUE OF THE ITEM OR ITEMS. If you fail to do so, the Board will assign an estimated value. - 3 O This statement will benefit you, because it will be used to prevent an excessive compensation rate, and will insure the payment of compensation at the correct rate in this claim. ' o o o Return To: INDUSTRIAL ACCIDENT BOARD o W ALTON BUILDING AUSTIN, TEXAS o 2 CAUTION: BE SURE TO COMPLETE REVERSE SIDE OF THIS FORM . ... _ . a v io r>\ / *r/*s Pi A n O y ,EE C k i , R E t H f U t W liH A 5 fM 9 R C E 6 # VtiOStf . 0 Roses? Fsah* R AM* Jt* * * Watmc RUs , ' MlHOSS, I23O CS** Stscct 0 Sa* A i o m i o Tt**f 5 0 Mi* Ruot ft** M i o n u t * *17 South H* ,, Sa i Ai t o * # Tea** 0 em ployer C o r a C ohRAu t VA 102% N* IROUATlI At tvO Da l l a s Te*** DATE NOTICE M AILED CLAIMANT Y - 3-59 IN SURANCE CO. NO. DATE OF H E A IIN G 7-23-59 BOARD NUMBER 3 6(A73 INDUSTRIAL ACCIDENT BOARD WALTON BUILDING AUSTIN 14, TEXAS Claim for compensation from the employee named at left will be heard on "Date^ofj Hearing" shown above. Below ,,are~ requests for Employer's First Report l' fin ju ry and wage information.Only those --.V I ^checked are being requested. 0 IN SU R A N C E C A R R IE R T kc Tr a v e l e r s Imsuramcc Co u r a it J IO SC A 8 0U C H SLO tt* S UST** TCAAS 0 MR* J ames DATE OF IN JU R!6 - 7 * 0 / S croch NATURE OF IN JU RY 1 0 -7 -5 7 W H EN W R IT IN G TO T H E BOARD CONCERNING T H IS CLAIM ALW AYS G IVE T H E BOA R D 'S NUM BER AND STYLE OF THE CASE. COUNTY WHERE IN JU RY OCCURRED Bexar r ^ f R RE EQQUUEST FOR EMPLOYER'S FIRST REPORT OF INJURY 0 No report of this injury has been received by the Industrial Accident Board. W e call your attention to Section 7, Article 8307, Texas Civil Statutes, requiring every employer carrying Compensation insurance to keep a record of all injuries sustained by his employees in the course of their employment, and to report same to the Board within 8 days, if the employee loses more than -- 1 day's time from his work on account of the injury^A severe penalty of not exceeding $1,000 is provided for failure to make Q such injury report. You should also furnish a c o p / o f this First Report of Injury to your insurance carrier, if you have not already done so. x ~ rT T REQUEST FOR WAGE INFORMATION 1-- 1 On the reverse side is Employer's W age Statement which the Board requires that you complete and return to this office prior J L to Date of Hearing" shown above. This information is requested for the 12-month period immediately preceding "Date of 0 In ju r/' given above. If this employee has worked for you less than one year, you should submit a summary of wages for an employee of the sameL class, working substantially the whole of the immediately preceding year in the same or a similar employ ment If you furnish an employee board, lodging, laundry, fuel or other advantages in addition to regular wages, or if the 0 employee received tips or other gratuities for services, BE SURE TO G IV E THE ESTIMATED VALUE OF THE ITEM OR ITEMS. If you fail to do so, the Board will assign an estimated value. 3 ' 0 This statement will benefit you, because it will be used to prevent an excessive compensation rate, and will insure the payment of compensation at the correct rate in this claim. 0 0 0 Return To: INDUSTRIAL ACCIDENT BOARD 0 WALTON BUILDING AUSTIN, TEXAS 0 3 LAR.a.sa CAUTION: BE SURE TO COMPLETE REVERSE SIDE OF THIS FORM SFNn d n f rn P Y TO YOUR INSURANCE CARRIER; RETURN ONE COPY TO BOARD June 30, 1959 The Travelers Insurance Company 201 S* St, Mazy* s Street 8 Antonio 5 Texas / Genties@ii Attention! Hr* H* W, Hill Sabi eett' Clareno H. Seed Cl ala #3-8742139 The following figures indicate the entire employment in Texas by Armstrong Coilc Coapsny of Clarence H# Bead, S.S. #216-10-7857 fa y Biding 8/25/57 9 /V 5 7 9 A 5 /5 7 9/22/57 Mi $ 77.28 77.28 77.28 77.28 Peers 3 3 3 .1 Rom 24 24 24 24 $309.12 12 96 Daring the above eaployaent, ve did not submit an accident report, and our records Indicate both terminations were due to lade of work. Yery truly yours, ARMSTRONG CORK COMPAHI B, C, Schiedt, Jr, Insurance Department JE2 E. J. Stem, AC&S, Dallas J. E. Zeller, AC&S, Lancaster (^ Jl P \ J^ (U L Pix>^ wjx^v-^ ; F v s- ^7 * . -JU L -d l tocy^ I 77A ? ? ~!S - J " ? ! \ f ' 1 112$ i I ` - , 7727 '^XcfaJl^ i ` { na? \ -- ' 1 ! i 3 6 9 JA ! i i t 1 1 i * i t ; i t l > ' 1 j ' i : .:.'| i : ! ; i i ? fs? 2-J) -s? 9-//-S7 i % ! Z -**-*"* 9-/f- r ? ^ jt c U tjL . I - J . ! ! " / : , Z. ^ 6: 7 M n C ^ ^-L^a-<J i # 11,1 IN T E R t 'O F F IC E C O M M U N IC A T IO N To From Subject J. E. Zeller, Lancaster E. J. Stem, Dallas Claim for Compensation for Death Clarence H. Reed . Social Security #216-10-7857 'Ct> (AVm strong c June 25, 1959 i /> j . f 4* > .V K, AIR MAIL ' On June 19, we wrote to you with reference to the above claim. Attached please find letter from The Travelers requesting further information in this regard. We have checked our records again and herewith is a tabulation of our records of his employment: Week of 1957 8/19-8/25 8/26-9/1 9/9-9/15 9/16-9/22 Dates Worked 21 22 23 26 27 28 11 12 13 16 17 18 Total Hours 24 24 24 24 Rate $ 3.22 3.22 3.22 3.22 Gross $ 77.28 77.28 77.28 77.28 You will find copy of Employer's Wage Statement enclosed and no doubt, you will want to check your Lancaster records before completing the Statement. We- have searched our files and cannot find that a First Report of Injury was ever reported to us or filed with the Industrial Accident Board in Austin, Texas. Please advise us of anything further that we can do in this connection. LB Enclosre ,. H. T. Miller, San Antonio CLAIM DEPARTMENT PAUL W . BOGUSCH, Claim M a n a g Jana 2 2, BRANCH OFFICE ^yPetroleup.m.. C--om--m--er-c-e--B-u-i-ld--in-g J 201 North St. Mary's Street ScAi uM AiMNTTOnwNIiOn 5a., TTEEXXAASS > ** Telephonat CApitol 5-7661 Armstrong Cork Company Plantation Road' Dallas, Texas JUH* B-87h2139 Armstrong Cork Company Re: Clarnce H. Reed D/L: 8 - 5 7 B-8712076 B & B Supply Company Re: Clarence H. Reed D/L: 5-1-59 Gentlemen: We have been advised of a claim for compensation of beneficiaries of Clarence H. Reed througi their attorney, Mr. Rudy Rxde, of San Antonio^Texas. Such claim is for death benefits under Workmen's Compensation Act, death caused by e s b e s t o e i s . ^ aliege ly worked for you during the months of August and September, 1957 Can An+rtniij Texas at the jobsite of the National Bank of Commerce `Building. A t is alleged that Clarence H. Reed breathed asbestos dust and b e c L e ' infected with asbestosis and subsequently died on December 29, 1958. Would you please forward to us the employment dates of Clarence H. Reed and also forward a first report of injury - compensation, Clarence H. Reed ever advised you of such an injury. We are also forwarding for your attention Employer's Wage Statement f o r 7 o ^ 5 t t c n " or thf weekly wages of Clarenoe H. Seed for the peiaod of time that he was employed by you. We would appreciate a prompt reply to this letter as w e anticipate.an early hearing before The Industrial Accident Board and the possibility ol siit S S n g filed if such claim is denied by The Industrial Accident Board. Thank you for your attention in this matter. Very truly yours, HWH:rcw H O M E O F FI C E i [/ W. Hill,Adjuster 700 MA I N S T R E E T , H A R T F O R D 15, C O N N E C T I C U T FHPL&YER^S. wage statement * _ Please complete this Statement in detail in duplicate. N O T E : Return original to this office promptly. INDUSTRIAL ACCIDENT BOAR! ' *' ., A Send d u p licate to your i n s u r a n c e c a r r i e r ._________________________________ AUSTIN. TEXAS DAYS WORKED HOURS WORKED PERIOD COVERED BY EACH PAYMENT . fZhaw n u m b e r o f d a y s w o r k e d a nd amount 2]9C2 . . /lldU f , v liC i c u v u ., , ^ iuw ic ( J iiv * uw >< FROM MONTH DAY 1 TO MONTH 0 AY worked. 2 STATEMENT OF TOTAL EARNINGS OF 3 4 5 FROM 6 7 TO 8 9 ! . TATE MAXIMUM NUMBER OF HOURS 10 WHICH EMPLOYEE WAS PERMITTED TO WORK PER WEEK OR MONTH UNDER THE 11 PROVISIONS OF ANY ST ATIJ T E . REGULA- 12 TION OR AGREEMENT LIM I TING hours OF WORK. 13 HOURS PER UNDER 1 4 < ' * 15 16 2 _ HOW MANY DAYS CONSTITUTED A WEEK'S WORK? 3. HOW MANY HOURS CONSTITUTED A DAY'S WORK? 17 18 . t 19 20 21 22 4. IF EMPLOYEE WAS FURNISHED BOARD. 23 LODGING. LAUNDRY. FUEL. OR OTHER AD 24 VANTAGES HAVING A VALUE WHICH CAN BE ESTIMATED IN MONEY ( e x c lu d in g , h o w 25 ever, an y sum paid to employee to 26 cover any special expenses entailed on him by acts of his employment), 27 STATE ESTIMATED VALUE PER MONTH OF 28 EACH ITEM FURNISHED. 29 ITEM FURNISHED ESTIMATED VALUE 30 $ 31 32 ITEM FURNISHED ESTIMATED VALUE 33 $ 34 35 36 1 CERTIFY THAT THIS STATEMENT 37 IS TRUE AND CORRECT 38 39 DATE 40 41 CITY 42 STATE 43 44 45 SIGNATURE 46 47 48 OFFICIAL CAPACITY 49 50 51 EMPLOYER 52 OCCUPATION (Type of Work) WAGE RATE (By Hour, Day, Week, or Month) AMOUNT EARNED - A TOTAL DAYS WORKED TOTAL AMOUNT, EARNED . : ; : '- .-v-:. > -T.- - - ; S'1-" * a :->- - . y . s ' ,v - >j - > -*<-: . ; - f~ i >r-': v' \ V ^ 7 r \ ~ -f ?''. /-- ' Y" V /> o v .- .. --:., * * V " -r> . .... ; ' * Y. . , f^ 'r - * J; Y Cy . f ;l %-Xcl ,* - Enclosed are a letter f r o a t h e l a v offices of Kudy Rice, ^ly^outh Main^ .... j;. . San Antoalo'5*Tfexae*`id a Claim for;Compensation for Death in ? of the widow, Hr*7liila Esther Bead, .1230 Essex. Street, Sea.iatonio,':^/-^ s&7:j;77- wc '* ** . Y -\. .vVt */ n ". - "i.*- * * * , ,*?*} < . . ' -f '.-. - ->- * . *!?* v; - v * -T`"?~r - A*-! _ .dareaoe H. Reed vas employed in our Contract Operationa ^ariaE .the follow- .' Y i V ^ v - Please forward oae copy of the eaclos^ aaterial to the' proper office of -J' The Trayelers so that otir^iaterests aay' he ^ protected..... ~ - v :;Y ; - . .> Y C \ ,;.- r :V-i *;Y '} y ' ;'. ,.c 7 y Hofferth - 7.-v':.-v>`>V-*i^--:' ; . Assistant QGemneerraall Mannaaggeerr},-^? :K. ' .\* '1 '. Y.. - ^ r -, 7 "'3,-; . ---. , 7 "'7' i-` . ;_j.* 1 ^Y'v ".Y-?. - -'V*~ la sur's"*n**ce Depart"**val*4n*V Enclosures^ -..- p : - ,'r ,-' r;_. .' I 7: I S* 'yr^ r' rrS ^ tf Hr: ^ ' v* . - S C T l` M a > " . t-'-.''.'\\ ' | g ? . " '; . ; V : . ^ > <V:* - ` S x i '^ x n j a o , 3 , T e x a s '. .-": /-.. ; - r VT*k" ^ , y ` L ' . ; ^ f ^ v T s & T ! ; - ' ;* ' > ^ ** `J '* - _1- v - ;-` --'V- I - I . >-, f : V ' J t n ` >; '-'"V 7r v / 4 ^ ? - ^ V j ? {; v V ^ ^ V ''X;^'^:- V C : 7 J 7::.^'.p HICE -"7y -; } s ~ ^ ' l i S ^ U .>"' / ; ; T; ; i f ; J - : .,*.- */.;"iar. 1 - . -Saft*A n t o n i o / ; -,. ^.'_>t-*. 'if VI riSEt-srEs-e* t.itx ,w iT r * Claim for Compensation for Death INDUSTRIAL ACCIDENT BOARD ?V.,V'. - . ; ; AUSTIN, TEXAS . . . ' y N O T E --Tbi claim hoold V* mad ont hi duplicate: on copy llu r o f houli b maod to th Io au c trto l Accident Board and tk* o th ^ co p y V h O ttld b dT*r4 to th E m p lo ju r or ih In su ra n t Compaay or A*oc!*tlou c a r r jln * hU humr*.*. . TO. to to notify you S f ^ l s g>, , Namo of employ** o* oeUtloB or oompanjr w ith w hich em ployer U Incur**.. `"re , '\s Vjg'S?.,' , ' ' - 5 ' 7 :K *'- :-4- -f. \ .7. th a t I claim compensation from you under the Employera'. Liability Act of Texas on account of the death of " g ^ a d -- - i i i - i - l - ' o n th e .2 S th -- day of..fi&Sb-SL-- 1951--, Hu m of mploy**. . , . *->> ,* * - , . j,- ' -^.L`"' y v w '. V v-'-.-' - -v ' - which resulted the employ o f . - ^ s a s t g c a s - - C ^ h - C c ^ 2a ^ - ^ s ti t a fci o a D a l l a s Taaaa. The place of injury w ai " . " VV V i-'H-r * :* ~ i .-m , tut* nno or SMcrlptlo* of hU4iuff or plM * v fft#V- Anftoalflu T f c a c M L * ::v.' * "' '*? ...................................................... " The cause* of death was f i b r e &1 # ; itsd- ' - Ssapi i yf 1 - * 3 - 1- lAl 1 1 a j i ' ly;;A^Mraia'Cark.^Cgiaar "gloglratolT-tba,,jMea_gi Attgat a d S s t c d > > . . . 1 9 ? 7 ^ ; : ; :g ; g ^ l | g | g S t i g ^ ^ f : ' ? > :t g ^ ^ ^ :: Name and P. 0. address of witnesses lii support of claim: ..H ra i l n a _E A.thag -&agd.._.I23fl. .Tesai- Give names and P. 0 . address of the Beneficiaries of the deceased (stating the kinship of each such Benefit \ clary to the deceased) *. / : -` i-kg- , - - - - ** & a d - M ifa i- J t a b jg r t .'g r.^ a k _ M - 2 ia - ^ s a .- l? ' v ' i - . ; v ~ ` ; ;r . ; i - * r * v . --. f ^Which of the legal Beneficlaries above named are minors? \ J R o b e rt frsak ^ s3* 15 S tate ageshcT a--^-3^--U p --LB43p--S2td --J e r T } i^ '^ p s p ^ tp lj _ p n ^ t b* Wages of deceased employee on date of injury were $>ygg<M clcafc>ly4$pe*,-~r l l ^ wt<k w - * 'm}\ . ^ rDeceased was employed------- 3-(J--t--Pfr week V-. . sut whthr I or t day*. I Th i, riaiTr. for compensation, w ith respect to such injury and because of the death of deceased, is made inu bD eShi iaa Ulf Uo fi aUnJdU ifvoir ce*avc*h* a*n*d> all wm ov f t*h-- e leg al Be-n--e---fiicia-r--i-e---s-- of th e deceased, as well as by and for the under- eigned, he hreiri acting for biniseli and such legai Beneficiane. Social Security N. "j of Deceased--2 1 *iC-*-73-ST- th is .- _____ day of. i9-5a S lrn itu re of Clalm m t. l?.ia S a gj9iK.tgftaiL Rtrt nd la m b ir. s a A a to a io , T ^ xas ' City or town. / ivl" S r? ) A H JH S 3 [ ' nolle# and th# Silas of th# claim b#for* th# board.