APPLICATION FOR DEATH BENEFITS - CARANCI, JOHN C.

• Document Type: FOIA
• Keywords: PERSONNEL FILES
• Keywords: CARANCI JOHN
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0001411686
• 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: August 21, 1970

I. FULL NAME OF THE DECEASED (Last) (First) (Middle)
2. DATE OF BIRTH
3. DATE OF DEATH
MR
(Month) (Day) (Year)
(Month) (Day) (Year)
.
MRS CARANCI, John C.
Feb. 7, 1922
Jul 14, 1970
MISS
4. DOMICILE (Legal residence at time of
6. GIVE NAME OF EACH SPOUSE (Include all former marriages)
7. HOW WAS MARRIAGE TER-
8. DATE MARRIAGE WAS
death-City and State)
MINATED? (Check one in each
TERMINATED
P
o
id
case)
r
v
ence,
Ph n d P. T,-,
^ DEATH ? DIVORCE
c~-I q
9/21/64
S. HOW MANY TIMES WAS DECEASED
MARRIED?
^ DEATH ^ DIVORCE
Once
^ DEATH ^ 'DIVORCE
1. DEPARTMENT OR AGENCY IN WHICH LAST EMPLOYED
2. LOCATION OF LAST EMPLOYMENT
3. DATE OF FINAL SEPARATION
(City and State)
(Month) (Day) (Year)
Central Intelligence Agency
Washington, D.C.
Apr. 22, 1970
4. WAS DECEASED RETIRED AND RE-
S. IF RETIRED, GIVE SERIAL NUMBER,
6. DID DECEASED HAVE A SOCIAL SECU-
7. IF ANSWER TO ITEM 6 IS "YES,"
CEIVING CIVIL SERVICE ANNUITY?
IF KNOWN
RITY NUMBER?
GIVE DECEASED'S SOCIAL SECURITY
NUMBER
93 YES ^ NO
N.A.
YES ^ NO
8. IF DECEASED HAD RENDERED ACTIVE DUTY, WHICH TERMINATED UNDER HONORABLE CONDITIONS, IN ANY OF THE FOLLOWING SERVICES, COMPLETE THE SCHED-
ULE BELOW TO THE BEST OF YOUR ABILITY. IF AVAILABLE, ATTACH A COPY OF THE DISCHARGE CERTIFICATE.
(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 SERVICE AFTER JUNE 30, 1960; OR
(c) AS A COMMISSIONED OFFICER OF THE COAST AND GEODETIC SURVEY AFTER JUNE 30, 1961.
BRANCH OF SERVICE
SERIAL NO.
DATE OF ENTRANCE
ON ACTIVE DUTY
DATE OF SEPARATION
FROM ACTIVE DUTY
LAST GRADE
OR RANK
ORGANIZATION AT DISCHARGE
(Div., Regiment, Co., etc.)
U.S. Army
31182993
Oct-17,1942
Feb .5,194&
T-5
I. YOUR NAME (Last) (First) (Middle) 2. YOUR RELATIONSHIP 3. YOUR DATE OF
TO THE DECEASED BIRTH
MRS. (Month) (Day) (Year)
None
4. ARE YOU A CITIZE R TO ITEM 4 IS "NO," OF WHAT COUNTRY ARE
(Place an "X" in proper box)
? YES L NO
.Fill in items 6 through 14 if you are the widow or widower of the deceased~OCia _ _
6. DATE OF MARRIAGE
7. PLACE OF MARRIAGE (City and State)
8. MARRIAGE WAS PERFORMED BY
9. WERE YOU LIVING WITH DECEASED
(Month) (Day) (Year)
CLERGYMAN OR JUSTICE OF
^ THE PEACE
AT TIME OF DEATH?
^ OTHER (Specify)
^ YES ^ NO
10. WERE YOU EVER DIVORCED
12. GIVE NAME OF EACH SPOUSE (Include all former marriages)
13. HOW WAS MARRIAGE TER-
14. DATE MARRIAGE
FROM DECEASED?
MINATED? (Check one in each
WAS TERMINATED
^
case)
YES NO
^
^ DEATH ^ DIVORCE
If. HOW MANY TIMES WERE YOU
MARRIED?
^ DEATH ^ DIVORCE
^ DEATH, ^ DIVORCE
Items IS, 16, and 17 apply only if you are the widower of the deceased.
15. ARE YOU INCAPABLE OF SELF-
16. DID YOU RECEIVE MORE THAN
17. IF YOUR ANSWERS TO BOTH ITEMS 15 AND 16 ARE "YES," AND IF THE DECEASED!
SUPPORT BECAUSE OF DIS-
ABILITY.
ONE-HALF YOUR SUPPORT FROM
THE DECEASED?
DIED WHILE STILL EMPLOYED AFTER AT LEAST FIVE YEARS' CIVILIAN SERVICE,
^ YES ^ NO
^
O
[I
ATTACH A SEPARATE SHEET GIVING FULL PARTICULARS ABOUT YOUR DIS-
ABILITY AND THE EXTENT OF SUPPORT FROM THE DECEASED
YES
N
.
AP' ]CATION FOR DEATH BEN" ITS
' CIA RETIREMENT AND DISABILITY SYSTEM
(bl61
(b131
IMPORTANT.-To secure all possible benefits and to avoid delay: 1. Read carefully the "Information for the Applicant" on the reverse of this sheet;
2. Complete application in full; 3. If answer to any question is "no" or "none" so state; 4. Type or print in ink.
1. IF AN EXECUTOR OR ADMINISTRATOR HAS BEEN APPOINTED BY THE COURT TO SETTLE THE ESTATE OF THE
DECEASED, GIVE NAME AND ADDRESS OF THE EXECUTOR OR ADMINISTRATOR.
NAME
ADDRESS
APPROVED FOR RELEASE^DATE: 1845 Smith Street
North Providence, Rho .e Isl and.
10-Nov-2008 (CONTINUE ON OTHER SIDE)
2. IF AN EXECUTOR OR ADMINISTRA-
TOR HAS NOT BEEN APPOINTED,
WILL ONE BE APPOINTED?
^ YES ^ NO
 E. INFORMATION CONCERNING DEPENDENT CHILDREN OF THE DECEASED
HIS
UNDER
WERE
WHO
LIST SURVIVING
DEATH. CHILDREONW TEPCHIILDR N, ANDAILR LEGIT MATED CHILD ENE ADECEASED ND INDICATE AFTER THEIR THTHE T ARE ADOPT D, ILLLEG T MA E, ORS TEPCHIL RENOPTED LEGALLY !INCLUDE ALSO ANY UNMARRIED CHILD BETWEEN 18 AND 21 IS A
JUNE 30) IS DEEMED NOT TO
AFTER EACH SUCH CHILD'S NAME. (AASTUDENT WHOSE O21ST BIRTHDAYS FASTUDENT IN A LLS DURING AE SCHOOL YD EAEDUCATIONAL R (SEPT EMBER INSTITUTION.
ATTAIN AGE 21 UNTIL THE FOLLOWING JULY 1. HOWEVER, IF YOU LIST SUCH A CHILD, BE SURE. TO SHOW HIS ACTUAL DATE OF BIRTH.)
INCLUDE ALSO ANY UNMARRIED CHILD OVER 18 WHO BECAME DISABLED BORE AGE IB AND WHO, BECAUSE OF THE DISABILITY, IS INCAPABLE OF SELF-SUPPORT.
DATE OF BIRTH
(Month) (Day) (Year)
DID CHILD RECEIVE
MORE THAN ONE-
HALF HIS SUPPORT
FROM DECEASED(
^ YES 23
^ YES ^ NO
^ YES ^ N
^ YES ^ NO
^ YES ^ N
NAME AND ADDRESS OF PERSON WHO NOW HAS THE
CHILD AND HIS (OR HER) RELATIONSHIP TO THE
CHILD
YES ^ NO
IF ANY STEPCHILD OR ILLEGITIMATE CHILD LISTED ABOVE WAS NOT LIVING WITH THE DECEASED AT THE TIME OF HIS (OR HER) 3' IS HERE D C UNBORN CHILD
DEATH, GIVE NAME OF CHILD AND EXPLAIN BRIEFLY WHY THEY WERE LIVING APART. ^ OF EASED?
YES ? NO
GUARDIAN
HAS 4. IF A GUARDIAN HAS BEEN APPOINTED BY THE COURT FOR ANY OF THE CHILDREN LISTED ABOVE, GIVE GUARDIAN'S NAME AND 5. BEEN A POINTED, WILLNOT
ONE BE APPOINTED?
ADDRESS ^ YES ^ NO
F. INFORMATION CONCERNING NON-DEPENDENT CHILDREN AND OTHER RELATIV S OF THE DECEASED
I. LIST BELOW THE NAME, AGE, ETC., OF THE DECEASED'S WIDOW OR WIDOWER.
2. IF NO WIDOW OR, WIDOWER SURVIVES. LIST ALL CHILDREN OF THE DECEASED NOT NAMED IN ITEM E, AND THE DESCENDANTS OF ANY DECEASED CHILD OR
CHILDREN. DECEASED IF THERE ARE
CENDAN 3. BROTHERS AND NOSISTERSCHIEN OR LDR(INDICATE SWHETH RTTHEF BRDECEASED OTHERS ANDLSSIIST RSLARE OF WHO ETORBHALF BLOOD WHEN BOTH DEGREES OF KINSHIP A E ANY INVOLVED.)
n
4. IF THERE ARE NO SURVIVORS WITHIN THE DEGREES INDICATED IN I, 2, AND 3, LIST THE HEIRS WHO CAN INHERIT FROM THE DECEASED.
WARNING-Any intentional false statement in
this application or willful misrepresentation rela-
tive thereto is a violation of the 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.)
NOTICE
Foreward application to the Director of Per-
sonnel, Central Intelligence Agency, Washington,
D.C. 20505.
I
G. CERTIFICATION
I hereby certify that all statements made in this application are true to the best of my
knowledge, information, and belief, and -that no evidence necessary to a. settlement of
this claim is suppressed or withheld.
INFORMATION FOR THE APPLICANT
Aug. / :1070
(DATE)
EVIDENCE REQUIRED
There must be submitted with this application a certified copy of
the public record showing the death of the employee or annuitant.
Failure to submit such death certificate will delay settlement of claim.
Any other necessary evidence not of record in the Central Intelli-
gence Agency will be requested after receipt of this application.
FINAL DETERMINATIONS
Upon receipt of this application, the Director of Personnel of
the Central Intelligence Agency will determine what benefits, if any,
are payable, the amount of such benefits, and to whom they are
payable. The Director of Personnel will inform the applicant of
the final determination.