APPLICATION FOR RETIREMENT - CARCANCI, JOHN C

• Document Type: FOIA
• Keywords: PERSONNEL FILES
• Keywords: CARANCI JOHN CHARLES
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0001464133
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 2
• Document Creation Date: June 22, 2015
• Document Release Date: December 31, 2008
• Case Number: F-2007-00327
• Publication Date: April 6, 1970

APPROVED FOR
RELEASE DATE:
10-Nov-2008
APPLICATION-FOR RETIREMENT
v. v ~ u 1 I- 1 1 1 J 1. 1 1. IVI
To avoid delay-I. Read information carefully; Complete app ication in full; Typewrite or print in i;,R
A. PERSONAL INFORMATION
I. NAME (Last)
MR (1`77 - (Middle) 2. DATE OF BIRTH
CORRES: 64 Veldt Street
CHECKS: rrS M coarrompm,
5. (A) ARE YOU
MARRIED?
^YES
NO
HER (OR HIS) BIRTH DATE
(Month) (Day) L (Year)
WIFE'S OR HUSBAND'S NAME
(First) (Middle)
D DISABILITY INFORMATION
1. OF ASSIGNMENT 2 SERVICE DESIGNATION 3. LOCATION OF EMPLOYMENT (City and State)
Do, C"o
F LAST POSITION 5.DATE O NAL SEPARATION (Month) (Day) (Year) 6. APPROXIMATE NUMBER OF YEARS OFol
CIVILIANS
$ 1 +
RVIC
~ ft
,
f
E
s .
E
U HAVE FEDERAL EMPLOYEES GROUP LIFE INSURANCE?
8. ARE YOU ENROLLED IN A PLAN UNDER THE FEDERAL EMPLOYEES HEALTH BENEFITS:
YES ^ NO
PROGRAM?
YES ^ NO
C. MI
LITARY SERVICE
1. COMPLETE THE SCHEDULE BELOW IF YOU HAVE PERFORMED ACTIVE DUTY THAT TERMINATED UNDER HONORABLE CONDITIONS IN ANY OF THE FOLLOWING SERV-
ICES: ((A ARMY, NAVY, MARINE CORPS, AIR FORCE, OR COAST GUARD OF THE UNITED STATES; OR (B) REGULAR CORPS OR RESERVE CORPS OF THE PUBLIC HEALTH
SERVIC~ AFTER JUNE 30, 1960; OR (C) AS A COMMISSIONED OFFICER OF THE COAST AND GEODETIC SURVEY AFT
YOUR DISCHARGE CERTIFICATE.
ER JUNE 30, 1961. IFAVAILABLE, ATTACH A COPY OF
BRANCH OF SERVICE
SERIAL NUMBER
DATE OF ENTRANCE
ON ACTIVE DUTY
DATE OF SEPARATION
FROM ACTIVE DUTY
.. LAST GRADE
OR RANK
ORGANIZATION AT DISCHARGE
(Div., Regt., Co., etc.)
iJ. .. AZMy
31 182993
A? C*t 42
5 A 46
TS
2. (A) ARE YOU A MILITARY RE-
SERVIST (EITHER ACTIVE
2. (B) ARE YOU IN RECEIPT OF OR HAVE YOU EVER APPLIED FOR
MILITARY RETIRED PAY? (RETIRED PAY DOES NOT IN-
2. (C) IF "YES," WERE YOU RETIRED FROM A RESERVE COMPO-
NENT UN
OR INACTIVE)?
CLUDE V.A. PENSION OR COMPENSATION.)
DER CHAPTER 67, TITLE 10, U.S.C. (FORMERLY
TITLE 111, PUBLIC LAW 80-S10)?
^ YES LJ NO
^ YES M NO
^YES ^ NO
E. OTHER CLAIM INFORMATION
2. BRIEFLY DESCRIBE YOUR DISABILITIES. STATE WHEN INCURRED, AND HOW THEY INTERFERE WITH PERFORMANCE OF THE DUTIES OF YOUR POSITION. (ATTACH
ADDITIONAL COMMENTS ON PLAIN SHEET OF PAPER IF NECESSARY.)
1. (A) HAVE YOU EVER RECEIVED OR MADE APPLICATION FOR COMPENSATION
UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT'
Will 4%"ty
RE YES
2. (A) HAVE YOU PREVIOUSLY FILED ANY APPLICATION UNDER THE CIVIL SERVICE
RETIREMENT SYSTEM, INCLUDING APPLICATION FOR RETIREMENT, REFUND,
DEPOSIT OR REDEPOSIT, OR VOLUNTARY CONTRIBUTIONS?
^YES N
!3. (A) HAVE YOU PREVIOUSLY FILED ANY APPLICATION UNDER THE CIARETIRE-
MENT & DISABILITY SYSTEM, INCLUDING APPLICATION FOR RETIREMENT,
REFUND, PURCHASE OF SERVICE CREDIT, OR VOLUNTARY CONTRIBUTIONS?
y
E=:1 YES ^ NO
I, (B) IF "YES," STATE THE NUMBER OF YOUR COMPENSATION CLAIM.AND THE
PERIOD FOR WHICH YOU RECEIVED COMPENSATION__
CLAIM NUMBER
FROM (Month) (Da
) (Year) ' .70 (M
y
onth) (Day) (Y)
ear
2. (B) IF "YES," INDICATE THE TYPES) OF APPLICATION
AND GIVE THE CLAIM NUMBER(S) IF KNOWN
^`RETIREMENT ^ DEPOSIT OR REDEPOSIT
REFUND VOLUNTARY
^ CONTRIBUTIONS
3. (B) IF"YES," INDICATE THE TYPE(S) OF APPLICATION:
RETIREMENT PURCHASE OF SERVICE CREDIT
^ REFUND ^ VOLUNTARY CONTRIBUTIONS
4. (B) IF "YES," GIVE THE NAME OF THE OTHER RETIREMENT SYSTEM
Civil Service System
4. (A) HAVE YOU EVER BEEN EMPLOYED UNDER ANOTHER RETIREMENT SYSTEM
FOR FEDERAL OR DISTRICT OF COUMBIA EMPLOYEES?IR ^
X YES NO
SE/ET 7____""
DATE OF MARRIAGE
(Month) (Day) (Year)
B. CIVILIAN SERVICE
 INDICATE, BY SIGNING YOUR INITIALS APPROPRIATE 'BOX BELOW, THE TYPE OF ANNUITY YWNT TO RECEIVE. READ THE EXPLANATIONS AND
CONSIDER THE MATTER CAREFULLY. NO ANGE WILL BE PERMITTED AFTER AN ANNUITY HAS BEEN ANTED. = IF YOU WANT, AN ANNUITY WITH A SUR-
VIVOR BENEFIT, BE SURE TO GIVE THE OTHER INFORMATION CALLED FOR.
ri,
ANNUITY WITH SURVIVOR BENEFIT TO
WIDOW OR WIDOWER
SPECIFY THE PORTION OF YOUR ANNUITY YOU WANT. USED AS THE BASE
FOR YOUR WIDOW'S (OR WIDOWER'S) SURVIVOR ANNUITY.
11 you want all your annuity used as the base for the survivor
benefit, write the word "all" In the~box below. If you want
only part of your annuity used as the base for the survivor
benefit, write the yearly amount of your annuity you want used.
THE SURVIVOR'S ANNUITY WILL BE 55% OF ALL OR WHAT-
EVER PORTION OF YOUR ANNUITY YOU SPECIFY AS THE BASE
FOR HER (OR HIS) BENEFIT.
she (or he). dies. or remarries..
INITIALI
cc
ANNUITY WITHOUT SURVIVOR BENEFIT
(I do not desire my wife (or husband) to receive..a
survivor annuity benefit after my death.)
? If you are married, you will receive this type of annuity unless
you choose the annuity in Fl 2.
-40-0 The annuity payable to you during your lifetime will be reduced
the survivor benefit, plus 10% of any "amount over $3,600 so
used.
? If you retire for total disability before age 60 and get a guar-
anteed minimum disability annuity, you may use all or any part
of your "earned annuity as the base for the survivor benefit:
You cannot use anyex'tra annuity which may be payable to make
up the guaranteed minimum annuity.
? If your wife (or husband) should die before you, no change in
type of annuity will be permitted, your annuity will not be in-
creased, nor may you name any other person as survivor.
--? If you choose this type, :your.wife:(or husband) cannot be paid
a survivor annuity after your death.
? This type provides annuity payments, to-you only.
G. TYPES OF ANNUITY: UNMARRIED APPLICANTS ONLY (Including Widowed and Divorced)
ANNUITY WITHOUT SURVIVOR BENEFIT
ANNUITY WITH SURVIVOR BENEFIT TO
NAMED PERSON HAVING AN INSURABLE
INTEREST
SPECIFY THE NAME, RELATIONSHIP AND DATE OF BIRTH OF THE PERSON YOU WISH
TO RECEIVE THE SURVIVOR ANNUITY
SEE UNMARRIED EMPLOYEES UNDER INFORMATION REGARDING SURVIVOR
ANNUITIES ON THE ATTACHED INFORMATION SHEET FOR EXPLANATION OF REDUC-
TION IN YOUR ANNUITY.
? If you are not married, .you will receive this type of annuity
unless you choose the annuity in G. 1:
? This type provides annuity payments to you only.
? This type, is available to all retiring unmarried employees who are
in good health.
? It provides 'a reduced annuity to you and a survivor annuity to
the person named as having an insurable interest.
? The survivor's annuity will begin upon your death and end when
The survivor's annuity, will be 55% .of:the reduced annuity you
receive.
If you choose this type, you will have to undergo a medical
examination which will be arranged by the Director of Personnel
? If the person named as having: an insurable interest should die
before you, no change in type of ahnuity.wi l be permitted, your,
annuity will not be increased, nor may you name any other
person as survivor.
oo
violation application
WARNING~Any willful misrepresentation ll relative statement isl this
of the
e
law punishable by a fine of not more than $10,000 or imprisonment
of not more than 5 years, or both (18 U.S.C. 1001).
I hereby certify that all statements made in this application are, true
to the best of my knowledge and belief.
6 Apr 1970: /0/.John C. Caranci.
(DATE)
(SIGNATURE OF APPLICANTI
1. FOR OFFICE OF PERSONNEL USE ONLY
[INITIALS