a a

“
Le a EGE LOR

YE COR NE TNE AO,

$

EDWIN R.HAVENS,
LANSING ,MICH.

6B 90831]
6Y4 I0N : .

DROP REPORT—PENSIONER Me 1

- Cert. No. -

Pensioner ....

ak eal

Soldier .... | Siete a
Service --- :
Class ......--- | = ——

RECORD DIVISION |

. ae
In the above-described case & declaration filed

in this Division indicates that said pensioner died

ice Se eens

Chief, Record Division.

FINANCE DIVISION
SEP 16 ty3l es

The name of the above-described, pensioner who

was last paid at the rate of $ . per month
AUG

oS
to pecs , 19...-.-, has this day

been St BOOS the roll because of Death
: 2$§, (> J

O. J. RANDALL‘
Chief, Finance Division.

6—2249  u. & GOVERNMENT IRINTING OFFIOS: 1037