APPLICATION FOR RETIREMENT - CARNCI, JOHN

• Document Type: FOIA
• Keywords: CARANCI JOHN
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0001426566
• 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
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(WHEN FIL IN)
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1111161
1111131
APPLICATION FOR RETIREMENT
CIA RETIREMENT AND DISABILITY SYSTEM
To.avoid delay-I. Read information carefully; Complete application in full;
A. PERSONAL INFORMATION
1. NAME (Lost)
MR.
Mss' CARANCI
John
CORRES: 64 Eddi Street
CHECKS: Same as Correspondence
5. (A) ARE YOU
MARRIED?
^ YES
? NO
(Middle)
C
WIFE'S OR HUSBAND'S NAME
(First) (Middle)
ypewrite or print in in
2. DATE OF BIRTH
(Month) (Day) (Year)
Feb 7 1922
Centredale, Rhode Islan
DATE OF MARRIAGE
(Month) (Day) (Year)
13. CIVILIAN SERVICE
HER (OR HIS) BIRTH DATE
(Month) (Day) (Year)
DD~
Washingt
4. TITLE OF LAST POSITION
Devel. & Eng. Technologic
7. DO YOU HAVE FEDERAL EMPLOYEES GROUP LIFE INSURANCE?
? YES ^ NO
8. ARE YOU ENROLLED IN A PLAN UNDER
PROGRAM?
JS IN ANY OF THE FOLLOWING SERV
;ERVE CORPS OF THE PUBLIC HEALTH
. IF AVAILABLE, ATTACH A COPY CF
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.)
U. S. Army
31 182993
17 Oct 42
5 Feb 46
T5
2. (A) ARE YOU A MILITARY RE-
2. (B) ARE YOU IN RECEIPT OF OR HAVE YOU EVER APPLIED FOR
2. (C) IF "YES," WERE YOU RETIRED FROM A RESERVE COMPO-
SERVIST (EITHER ACTIVE
MILITARY RETIRED PAY? (RETIRED PAY DOES NOT IN-
NENT UNDER CHAPTER 67, TITLE 10, U.S.C. (FORMERLY
OR INACTIVE)'
CLUDE VA PENSION OR COMPENSATION.)
TITLE III, PUBLIC LAW 80-810)?
^ YES LJ NO
^ YES IN NO
^ YES ^ NO
on, D. co
6. APPROXIMATE NUMBER OF YEARS OF
CIVILIAN SERVICE
E FEDERAL EMPLOYEES HEALTH BENEFITS
? YES ^ NO
1. COMPLETE THE SCHEDULE BELOW IF YOU HAVE PERFORMED ACTIVE DUTY THAT TERMINATED UNDER HONORABLE CONDITIOI
ICES: (A) ARMY. NAVY. MARINE CORPS, AIR FORCE, OR COAST GUARD OF THE UNITED STATES: OR (B) REGULAR CORPS OR RE
Only applicants for total disability retirement will
complete Part D.
02911
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
1. (8) IF "YES." STATE THE NUMBER OF YOUR COMPENSATION CLAIM AND THE
UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT?
PERIOD FOR WHICH YOU RECEIVED COMPENSATION
Will Apply ? ^
YES NO
CLAIM NUMBER
FROM (Month) (Day) (Year)
1TO (Month) (Day) (Yew
2. (A) HAVE YOU PREVIOUSLY FILED ANY APPLICATION UNDER THE CIVIL SERVICE
2. (B) IF "YES," INDICATE THE TYPE(S) OF APPLICATION
E
RETIREMENT SYSTEM, INCLUDING APPLICATION FOR RETIREMENT. REFUND,
R(S) IF KNOWN
AND GIVE THE CLAIM NUMB
CLAIM NUMBER(S)
DEPOSIT OR REDEPOSIT, OR VOLUNTARY CONTRIBUTIONS?
^ RETIREMENT ^ DEPOSIT OR REDEPOSIT
?
^
VOLUNTARY
^ REFUND ^
YES
NO
C ONTRIBUTIONS
3. (A) HAVE YOU PREVIOUSLY FILED ANY APPLICATION UNDER THE CIA RETIRE-
3. (8) IF "YES," INDICATE THE TYPE(S) OF APPLICATION:
MENT & DISABILITY SYSTEM, INCLUDING APPLICATION FOR RETIREMENT,
REFUND, PURCHASE OF SERVICE CREDIT. OR VOLUNTARY CONTRIBUTIONS?
^ RETIREMENT ^ PURCHASE OF SERVICE CREDIT
YES ^ NO
^ REFUND ^ VOLUNTARY CONTRIBUTIONS
4. (A) HAVE YOU EVER BEEN EMPLOYED UNDER ANOTHER RETIREMENT SYSTEM
4. (B) IF "YES," GIVE THE NAME OF THE OTHER RETIREMENT SYSTEM
FOR FEDERAL OR DISTRICT OF COUMBIA EMPLOYEES? M
^ NO
Civil Service S
stem
YES
y
FORM 3102 4-65 S a.,.
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 INDICATE, BY SIGNING. YOUR INITIALS IN THE APPROPRIATE BOX BELOW, THE TYPE OF ANNUITY YOU WANT TO RECEIVE. READ THE EXPLANATIONS AND
CONSIDER THE MATTER CAREFULLY. NO CHANGE WILL BE PERMITTED AFTER AN ANNUITY HAS BEEN GRANTED. IF YOU WANT AN ANNUITY WITH A SUR-
F. TYPES OF ANNUITY: MARRIED APPLICANTS ONLY
ANNUITY WITH SURVIVOR BENEFIT TO
WIDOW OR WIDOWER
SPECIFY THE PORTION OF YOUR ANNUITY YOU WANT USED AS THE BASE
FOR YOUR WIDOWS (OR WIDOWER'S) SURVIVOR ANNUITY.
.j cc
if you want all your annuity used as the base for the survivor
benefit, write the word "all" in the be. below. if you want
only part df'your annuity used as the base for the survivor
benefit, write the Yegrly 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.
ANNUITY WITHOUT SURVIVOR BENEFIT
you choose the annuity in F. 2.
The annuity payable to you during your lifetime will be reduced
by 2V,7. of any amount up to $3,600 a year used as the base for
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 any'extra 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.
? This type provides annuity payments to you_ only.
G. TYPES OF ANNUITY: UNMARRIED APPLICANTS ONLY (Including Widowed and Divorced)
survivor annuity benefit after my death.)
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
NAME OF PERSON (First, middle, fail)
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. 2.
? 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
she (or he) dies.
? 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
at no cost to you. .
? If the person named as having an insurable interest should die
before you, no change in type of annuity willbe'permitted, your
annuity will not be increased, nor may you name any other
person as survivor.
WARNING-Any intentional false statement in this application
or willful misrepresentation relative 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).
I hereby certify that all statements made.in.this application are true
to the best of my knowledge and belief.
6 Apr. 1970 . Is./ John C. Caranci
(DATE) (SIGNATURE OF APPLICANT)