[Deceased Personnel Within the Continental United States Excluding Alaska (AR 600-550)]
[From the U.S. Government Publishing Office, www.gpo.gov]
NON-CIRCULATING
DECEASED PERSONNEL
WITHIN THE CONTINENTAL
UNITED STATES, EXCLUDING
ALASKA
(AR 600-550)
IVAR DEPARTMENT
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WAR DEPARTMENT TECHNICAL MANUAL
JANUARY 1945
IM 12-240
0 1
TECHNICAL MANUAL
DECEASED PERSONNEL WITHIN THE CONTINENTAL UNITED STATES, EXCLUDING ALASKA (AR 600-550)
A
WAR DEPARTMENT Washington 25, D. C., 1 May 1945
Changes
No. 1
TM 12-240 is changed as follows:
AGO 506A-Apr.
Pages 4 and 5, change title to “Notifications for Decease Due to Aircraft Accident and Major Disaster.”
Page 5, Add notification from Commanding Officer Nearest Army post to emergency addressee or his designated receiving funeral director in all cases to arrange for disposition of remains.
Page 7, paragraph 7, change first sentence to “If the troop train commander has available responsible military personnel, preferably an officer whom he can detail to stay with the deceased until aid arrives, he will do so.”
Page 9, under “Local Health Authorities,” add sentence, “If necessary, prepares Certificate of Death.”
Page 12, second sentence under Chief of Service or His Designee, change to “If commanding officer requests autopsy be performed on military personnel, chief of laboratory service performs autopsy. AR 600-550.”
Pages 12, 13, and 15, delete copy of Certificate of Death prepared and forwarded to United States Census Bureau in accordance with C4 AR 40-1080.
Page 19, under Commanding Officer., Prepares a sixth part of WD AGO Form 52-5 to be forwarded to Purchasing and Contracting Officer.
Remove pages 21 and 22, and substitute revised pages 21 and 22, herewith.
Page 23, WD AGO Form 52-5, Initial Report of Death, item “S.” Change wording “Was deceased on active duty status” to “Was deceased on duty status.”
Page 27, second sentence under Note 1, change to “If after a reasonable time he is not claimed, the deceased is entitled to be buried in a national cemetery. AR 30-1820.”
Page 31, note is applicable to conditions A, B and C, section 7.
Page 37, delete reference to Army War Bond Office, Chicago, Illinois, and copy of WD AGO Form 30-S, sent to former AWB.
[AG 300.5 (19 Apr 45)]
AGO506A—Apr. 637401’—45
1
TM 12-240
c 1
By order of the Secretary of War:
Official: G. C. MARSHALL
J. A. ULIO Chief of Staff
Major General
The Adjutant General
Distribution:
AAF (5); AGF (5); ASF (2); AAF Comds (2); Arm & Sv Bds (2); Def Comd (5); S Div ASF (1); Tech Sv (2); SvC (5); MDW (5); PC&S (1); GH (2); SH (2); Conv C (2); Gen & Sp Sv Sch (2); A (2); CHQ (2); D (1); B (1); R (1); Bn (1); C (1); AF (2). NO OVERSEA DISTRIBUTION.
Refer to FM 21-6 for explanation of distribution formula.
400 SOSA
I. >. •OVKRNMZNT PRIWTIRR RFFICIi l»4»
2
1 MAY 1945 TM 12-240
c 1
TELEGRAM TO EMERGENCY ADDRESSEE
....WAR DEPARTMENT
| MESSAGEFORM Dafe 24_July_l?44_________
File No. ..1.25_______________ Telephone No. ..................................................
H Office of origin..........Headquartera............................................„......FDCG......
(Ann or service) (Division) (Bnncb) (Section) (Symbol)
Address................?........................................................................ •
Q PRECEDENCE
To: | | WIRE OR RADIO ESSENTIAL MniTARY MAIL
Urgent........ Air mail..................
®* THOMAS C. DOE Priority....... Special delivery..........j-SS
27 HILLSIDE AVENUE iu,^. COM WIRE Ordinary............ . . ..._
WOODSTOCK , CONN* Deterred....... Registered..................
[ Weekend...................................
Initial of officer
Any menage not X’d for precedence rm**d.n<*
will be sent "Deferred."
MESSAGE:
I REGRET TO INFORM YOU THAT YOUR SON PRIVATE JOHN JAMES DOE HAS DIED DUE TO INJURIES RECEIVED IN A MOTOR VEHICLE ACCIDENT AT FORT DIX NEW JERSEY ON JULY TWENTY THIRD STOP LETTER FOLLOWS STOP THE DECEASED IS NOW AT TILTON GENERAL HOSPITAL STOP KINDLY WIRE COLLECT WHETHER YOU DESIRE REMAINS SHIPPED DIRECT HOME OR DIRECT TO A NATIONAL CEMETERY STOP LONG ISIAND NATIONAL CEMETERY FARMINGDALE LONG ISLAND NEW YORK IS NEAREST YOUR HOME STOP IF SHIPMENT HOME IS DESIRED PLEASE FURNISH NAME AND ADDRESS OF FUNERAL DIRECTOR SELECTED BY YOU TO RECEIVE REMAINS AT DESTINATION STOP IF SHIPMENT DIRECT TO A NATIONAL CEMETERY IS DESIRED PLEASE DESIGNATE BY NAME NATIONAL CEMETERY TO WHICH REMAINS SHOULD BE SHIPPED STOP FIFTY DOLLARS WILL BE ALLOWED TOWARD INTERMENT EXPENSES STOP KINDLY INCLUDE IN YOUR WIRE THE NAME AND ADDRESS OF A PERSON DESIGNATED TO INCUR THESE INTERMENT EXPENSES STOP MY DEEPEST SYMPATHY IS EXTENDED TO YOU AND MEMBERS OF THE DECEASED FAMILY AT THIS TIME END
MADISON PEARSON BRIGADIER GENERAL, USA COMMANDING
W.D..A.C.O. ForrnNo.SOX y??. I?: ....... u- ’ coTTBNMtrr privtiAC orrtCC 16-31’37*2
Figure 8.
AGO 506A 21
1 MAY 1945
c 1
TM 12-240
LETTER OF SYMPATHY
HEADQUARTERS FORT DIX, NEW JERSEY
•24 July 1944,
Mrs. Thomas C. Doe 27 Hillside Avenue Woodstock, Connecticut
My dear Mrs. Doe»
It is with regret that I confirm the recent telegram sent to Mr. Thomas C. Doe informing him of the death''of your eon, Private John J. Doe, 2 468 109, Infantry.
Your son died as a result of injuries incurred while saving the lives of two members of the Army Nurse Corps. Seeing a large truck, out of control, about to run down the two nurses, he immediately ran to their aid, pushed them to safety, and was. struck by the oncoming truck. His death was instantaneous. I hope his courageous act may be of solace to you.-
Captain H. A. Campbell, Personal Affairs Officer,'Ft. Dix, New Jersey, has collected your son's personal effects and has forwarded them to you at the address above. If Captain Campbell can be of help to you in any manner, such as in making settlement of accounts, aiding you in applying for pensions or arranging to move the deceased's dependents and household goods, to their home, please communicate with him and he will furnish you any assistance possible. Or, you may feel free to call on the Personal Affairs Officer at an Army post nearer your home.
My heartfelt sympathy is extended to you and other members of your family in your bereavement..
Sincerely yours,
MADISON PEARSON
Brigadier General, USA Commanding
Figure 9t
22
AGO 508A
TECHNICAL MANUAL
TH 12-240
C 2
DECEASED PERSONNEL WITHIN THE CONTINENTAL UNITED STATES, EXCLUDING ALASKA (AR 600-550)
Changes]
No. 2
TM 12-240, 1 January 1945, is changed as follows:
Page 30, figure 13, in section 6A, second column under block labeled “Effects,” change second legend to read: Arranges for packing and shipment at Government expense, if requested.
Pages 40 and 41, figure 18 is changed as follows:
Under third column, “Investigating Officer,” change:
Medical Diagnosis from 2 copies to 3 copies.
Certificate of Commanding Officer from 2 copies to 3 copies.
Testimony of Witnesses, 3 copies.
Coroner’s Findings from 2 copies to 3 copies.
Under fourth column, “Surgeon,” change:
Medical Diagnosis from 3 copies to 4 copies.
Under fifth column, “Immediate Commanding Officer,” change:
Certificate of Commanding Officer from 3 copies to 4 copies.
Under seventh column “Coroner,” change:
Coroner’s Findings from 2 copies to 3 copies.
Pages 42 and 43, figure 19 is changed as follows:
Under second column, “Investigating Officer,” change:
Diagnosis from 2 copies to 3 copies.
Certificate from 2 copies to 3 copies.
Testimony from 2 copies to 3 copies.
Coroner’s Findings from 2 copies to 3 copies.
In the first set of blocks under third column, “Commanding Officer,” change:
[AG 300.7 (22 Aug 45)]
AGO 1669A—Aug. 656865°—45
>To Retain in AGO
Diagnosis Certificate Testimony Coroner’s
Findings
1
1
1
1
1
On arrow going to column entitled “Administrator of Veteran’s Affairs.”
WAR DEPARTMENT Washington 25, D. C., 27 August 1945 Diagnosis from 1 copy to 2 copies. Certificate from 1 copy to 2 copies. Testimony from 1 copy to 2 copies. Coroner’s Findings from 1 copy to 2 copies.
In the second set of blocks under third column, “Commanding Officer,” change:
Diagnosis from 2 copies to 3 copies. Certificate from 2 copies to 3 copies. Coroner’s Findings from 2 copies to 3 copies.
Under fourth column, “Service Command Personnel Branch,” change:
Diagnosis from 1 copy to 2 copies. Certificate from 1 copy to 2 copies. Testimony from 1 copy to 2 copies.
Coroner’s Findings from 1 copy to 2 copies.
Change the second set of blocks under fifth column, “The Adjutant General,” to read:
AGO 51 Diagnosis Certificate Testimony Coroner’s
Findings 2 & 3 AGO 51) 2 2 2 2
AGO 51
Diagnosis
Certificate
Testimony
Coroner’s Findings
Page 47, second column, delete “Government expense for shipment of effects—Prepaid.”
Change the first block under sixth column, “Administrator of Veteran’s Affairs,” to read:
1
1
1
1
1
1
TM 12-240
C 2
TEXAS ■
By order of the Secretary of War :
Official: G. c. MARSHALL
EDWARD F. WITSELL Chief of Staff
Major General
Acting The Adjutant General
Distribution :
AAF (5); AGF (5); ASF (2); AAF Comds (2); Arm & Sv Bd (1); Def Comd (5) ; S Div ASF (1); Tech Sv (2); Sv C (5); FC (1); Class III Instls (1); GH (2); SH (2) ; Conv H (2) ; Gen & Sp Sv Sell (2); A (2); CHQ (2) D (1); B (1); R (1); Bn (1); C (1); AF (2). No oversea distribution.
Refer to FM 21-6 for explanation of distribution formula.
AGO 1669A
0. f. GOVERNMENT PRINTING OFFICE: 1945
2
W A R DEPARTMENT TECHNICAL MANUAL
T M 1 2 - 2 4 0
DECEASED PERSONNEL WITHIN
THE CONTINENTAL UNITED STATES
EXCLUDING ALASKA
(AR 600-550)
WA R DE PA R T M E N T • JANUARY 1945
United States Government Printing Office Washington : 1945
WAR DEPARTMENT Washington 25, D. C., 1 January 1945
TM 12-240, Deceased Personnel within the Continental United States, excluding Alaska (AR 600-550), is published for the information and guidance of all concerned. [AG 300.7 (14 Oct 44)]
By order of the Secretary of War:
Official: , G. C. MARSHALL
J. A. ULIO Chief of Staff
Major General
The Adjutant General
Distribution :
AAF (5) ; AGF (5) ; ASF (5) ; AAF G (2) ; Arm & Sv Bd (2); Def C (5) ; Tech Sv (2); SvC (5); MDW (5); PC&S (1); GH (2) ; SH (2); Conv Ctr (2);Gen&Sp Sv Sch (2); A (2) ; CHQ (2) ; D (1);B (1);R (1); SBn (l);Bn (1);C (1); AF (2).
Oversea distribution will not be made.
For explanation of symbols, see FM 21-6.
i
ii
CONTENTS
Page CHAPTER 1. GENERAL............................................................... 1
CHAPTER 2. NOTIFICATIONS REQUIRED FOR DECEASE DUE TO AIR-
CRAFT ACCIDENT............................................... 2
Notifications Required for Decease Due to Aircraft Accidents (WD Circular 373, 1944)—Flow Chart..................................... 4-5
CHAPTER 3. INITIAL NOTIFICATIONS REQUIRED FOR DECEASE OCCURRING ON TROOP TRAINS............................................................ 7
Decease Occurring on Troop Trains—Initial Notifications Required— Flow Chart................................,..................... 8-9
CHAPTER 4. ADMINISTRATIVE PROCEDURE FOR DECEASE IN U. S. ARMY HOSPITALS...................................................................... 11
Administrative Procedures when Death Occurs in a United States Army Hospital—Flow Chart..............•....................... 12-13
Preparation and Disposition of Hospital Death Report.... 12-13
Preparation and Disposition of the Certificate of Death when
Coroner is Not Required to Sign Certificate. . ...... 12-13
Preparation and Disposition of Certificate of Death when Coroner
is Required to Sign Certificate........-............. 12-13
Hospital Report of Death, WD AGO Form 52-9 — Illustration...... 14
Certificate of Death—Illustration................................ 15
CHAPTER 5. IMMEDIATE NOTIFICATIONS REQUIRED FOR ALL DECEASED PERSONNEL................................•.............................. 17
Immediate Notifications within Twenty-four Hours upon Decease of Personnel Subject to Military Authority—Flow Chart........ 18-19
Preparation and Disposition of Letter of Sympathy....... 18-19
Notification by Surgeon—Illustration............................. 20
Telegram to Emergency Addressee—Illustration................ . 21
Letter of Sympathy—Illustration.................................. 22
Initial Report of Death—WD AGO Form 52—5—Illustration............ 23
CHAPTER 6. DISPOSITION OF DECEASED PERSONNEL................................ 25
Disposition of Deceased and Notifications Required—Flow Chart.. 26-27
Property Issue Slip, WD AGO Form 446—Illustration................ 28
CHAPTER 7. EFFECTS OF DECEASED PERSONNEL.................................... 29
Effects of Deceased Persons—Disposition of—AW 112—Flow Chart. . . . 30-31 “If Legal Representative or Widow of Deceased is Present,” AW 112— 30-31 When Legal Representative or Widow is Known, is not Present and “Commanding Officer shall direct a Summary Court to Secure all Effects,” AW 112........................................... 30-31
When Legal Representative, Widow, or Next of Kin is not Known and “Commanding Officer shall direct a Summary Court to Secure all Effects,” AW 112......................................... 30-31
Inventory of Effects, WD AGO Form 54 (front)—Illustration........ 32
Report of Summary Court, WD AGO Form 54 (back)—Illustration ... 33
CHAPTER 8. PREPARATION AND DISPOSITION OF FINAL PAPERS.................... 35
Preparation and Disposition of Allotment Discontinuance, Final Pay-
ment Roll, Service Records and Allied Papers—Flow Chart..... 36-37
Final Payment Roll, WD Form 371—Illustration..................... 38
CHAPTER 9. REPORTS OF INVESTIGATION......................................... 39
Preparing Report of Investigation and Inquest of Death—Flow Chart. . . 40-41 Processing Reports of Investigation of Deceased Personnel for Determina-
tion of Line of Duty—Flow Chart............................. 42-43
Follow-up of a Delayed Report of Investigation of Deceased Personnel.... 42-43
Report of Investigation, WD AGO Form 51—Illustration............. 44
Certificate of the Commanding Officer—Illustration............... 45
Testimony of Witness—Illustration................................ 46
CHAPTER 10. GLOSSARY......................................................... 47
in
1 Jan 45
TM 12-240
1
CHAPTER 1
GENERAL
1. PURPOSE.
This manual is based on the provisions of AR 600-550. It shows in detail the administrative procedures connected with taking care of deceased personnel within the continental United States, excluding Alaska.
2. SCOPE.
a. This includes simplifying the reporting procedure, expediting actual disposition of remains arid personal effects, and presenting of complete and accurate instructions and illustrations of necessary actions.
b. The reduction of paperwork accomplished by this manual is evidenced by the substitution of 3 basic forms for 12 forms. The consolidation and elimination of other forms is presented graphically as follows:
Forms
Old New
Notifications...................................
Requests........................................
Special orders..................................
Inventory of effects—Reports of summary courts, and related action..............................
Personnel forms.................................
Hospital administration forms...................
13
6
3
5
7
•5
8
2
1
1
4
1
Total..................................... 39 17
Signatures and copies have been correspondingly reduced. Forms have been redesigned for use in the standard typewriter and to allow ample space for entries.
3. CONTENT.
Important changes to the basic procedure relating to deceased personnel within the continental United States, excluding Alaska, set forth in AR 600-550, arc introduced in this manual as follows:
a. The Adjutant General will, in all instances, prepare the official War Department Report of Death, WD AGO Form 52—1, because—
(1) Completely accurate reports of death are necessary.
(2) Only The Adjutant General maintain^ those 201 files which contain all information needed to check the above report for all personnel.
b. A follow-up procedure on reports of investigation, where required, is established because—
(1) Delayed reports of investigation also delay the preparation of the official report of death.
(2) Until the Finance Officer, U. S. Army, receives the official report of death, he cannot make arrangement for payments of 6 months’ gratuity and arrears of pay.
c. The organization in possession of the service or personnel records prepares all reports, with the exception of the official War Department Report of Death, whenever possible.
4. ARRANGEMENT.
In the following sections, deaths occurring in unusual circumstances, such as those resulting from aircraft accidents and those taking place on a troop train, are discussed before deaths occurring at posts, camps, and stations. Materials have been arranged in this manner to indicate what immediate steps must be taken before routine procedures can be followed at the home station of the deceased.
1
TM 12-240
1 Jan 45
I
5
CHAPTER 2
NOTIFICATIONS REQUIRED FOR DECEASE DUE TO AIRCRAFT ACCIDENT
5. AIRCRAFT ACCIDENT.
In the case of an aircraft accident, the Army post locating the remains of the deceased will not necessarily have personnel records essential to make notification to the emergency addressee or to prepare the telegraphic report of death to The Adjutant General. Therefore, the Army post nearest the scene of the accident will notify the emergency addressee, if necessary information is available. However, if such information is not available, the home station of the deceased personnel will be notified. That station in turn will notify the emergency addressee and also
advise the Army post where the remains of the deceased are located of the name and address of the emergency addressee. The Army post handling the disposition of the deceased is authorized to communicate with the emergency addressee to provide for such disposition and to make such other arrangements as may be necessary. The home station of the deceased, normally in possession of the personnel records, will make the telegraphic report of death to The Adjutant General. See figure 1 for a graphic presentation of the above procedure.
3
TM 12-240
1 Jan 45
NOTIFICATIONS REQUIRED FOR DE
FIG. 1
COMMANDING OFFICER
COMMANDING OFFICER
COMMANDING OFFICER
SECTION I
DOCUMENT
HOME STATION OF
PERSONNEL
NOTIFICATIONS REQUIRED FOR DECEASE DUE TO AIRCRAFT ACCIO
SEARCH PARTY
TELEPHONE OR POST
TELEGRAPH TO NEAREST ARMY
TELEPHONE OR
ADDRESSEE
TELEGRAPH TO EMERGENCY
TELEPHONE TO
NEAREST AIR FORCE STATION
STATION OF DEPARTURE
NEAREST AIR FORCE
(IF NECESSARY)
STATION
-NT - (See W. D. Cir. 373, I9UU)
NOTE I
i- Any information received of aircraft accident involving personnel subject to military authority will be immediately reported to the Commanditg Officer of the nearest military instailat ion-post-camp-station-f ield.
The Commanding Officer of the nearest military installation will immediately undertake actions shown on this page.
- The key to prompt accurate casualty reporting of air crew members to locate and notify the home station of the personnel, so that data in the service records will be available.
- All notifications shown on this page will, if possible, be completad within 24 hours.
TELEPHONE
- Receives notification
- If necessary locates station of departure of flight
- Complies with AAF 62-I4»
r
I COMMUNICATIONS
AIR COMMUNICATIONS
COMMUNICATIONS
i
TELEPHONE
TELEPHONE
TELEPHONE
ADDRESSEE
OR TELEGRAPH TO EMERGENCY
TWX TO
THE ADJUTANT GENERAL
TELEPHONE OR TWX TO NEAREST ARMY POST (TO ACCIDENT)
- If necessary to establish identity of personnel receives notification
- Determines home station of personnel
- This step not necessary if home station of personnel known.
- If necessary to establish identity o.f oersonneb locates station of depar-i ture and requests identification of home station of personnel
- This step not necessary if home station of personnel known
TELEPHONE
- Receives notification including statement as to whether emergency addresses have been notified.
TELEPHONE OR TELEGRAPH
TELEPHONE OR TWX
- If emergency addressee has not been notified by nearest army post, not i f ies emergency addressee stating name and address of army post handling remains
- Sends TWX notification to the adjutant general
- Uses WDAGO 52-5 to prepare TWX.
- If required requests nearest army post to prepare report of investigation
- If emergency addressees have been notified by this army installation, advises the nearest army post of name and address of emergency addressee so they may communicate with EA to arrange for disposition of remains.
TELEPHONE
- If requested to locate home station of oer-sonnel advises nearest army oost of same
- This is not necessary if home station of
4
1 Jan 45 TM 12-240
CEASE DUE TO AIRCRAFT ACCIDENT
POINT OF ACCIDENT
COMMANDING OFFICER NEAREST ARMY POST
EMERGENCY ADDRESSEE
OR HIS DESIGNATED
FUNERAL DIRECTOR
THE ADJUTANT GENERAL
ta
SEARCH PARTY
- Finds aircraft, establishes guard, cares for Injured, secures all information poss i ble
- See Note 2 on AAF Regulation 62-14.
SEARCH PARTY
- Upon receiving information of nearby accident sends out search oarty to locate accident and equipped to administer a id.
- See Note I•
NOTE 2
- AAF Regulation 62-14 is not modified by this procedure and will be complied with. ,
- This procedure illustrates how AR 600-550*applies to AAF and other army installations to define:
- Who notifies the emergency addressee of decease.
- Who notifies the Adjutant General of deceased personnel.
- Who makes disposition of the remains.
- See AR 95-120 for further information.
TELEPHONE OR TELEGRAPH
TELEPHONE OR TELEGRAPH
- Telephones or» telegraphs all possible information to nearest army post.
- Receives notification.
TELEPHONE
OR TELEGRAM
I
TELEPHONE
OR TELEGRAM
I
- If emergency addressee is known, notifies emergency addressee requesting advice as to what disposition is to be made of deceased and designation of funeral director.
- Emergency addressee receives notification of decease.
TELEPHONE
(»
- Telephones nearest air force station as much information as possible.
TELEPHONE
NOTE 3
- Decease of members of The Army Air Transport Command within The United States and decease of members on flights, from their home station in The United States will be reported through their home station to, TAG who will make proper notification and reports.
- If necessary receives notification of home station of personnel.
TELEPHONE
TELEGRAM
TELEGRAM
- Emergency addressee-designated funeral director-advises what disposition is to be made of remains*
- Receives notification of dis-oosition of deceased-___________
TELEPHONE OR TWX
Phones all available information to the home station of oersonnel giving known name and serial numbers of deceased and statement as to whether emergency addressee has been notified.
(•
receives requests and prepares report of investigation under AR 600-550.
- Receives name and address of emergency addressee.
- If necessary to communicate with emergency addressee on disposition of remains, does so
- See following sections.
TELEPHONE
OR
TELEGRAPH
- Emergency addressee receives notification of decease.
♦ ™ I
- Receives.
- Uses as a basis for preparing report of death.
5
1 Jan 45
6
TM 12—240
CHAPTER 3
INITIAL NOTIFICATIONS REQUIRED FOR DECEASE
OCCURRING ON TROOP TRAINS
6. Most state laws prohibit moving a deceased person across a county or state line until the local authorities have been notified and the remains have been properly embalmed. The procedure following provides that the troop train commander place the deceased in the nearest undertaking establishment, notify the emergency addressee by wire, and notify the nearest Army post. If the nearest Army post is not known or is distant, he notifies the service command in which the remains are located. Having been advised by the nearest Army, post or the service command by telephone that aid is being sent to arrange for disposition of the deceased and to provide for necessary notifica-
tions, the troop train commander proceeds to his destination.
7. If the troop train commander has available an officer whom he can detail to stay with the deceased until aid arrives, he may do so. The nearest Army post or service command will furnish the necessary written orders detaching the officer.
8. For decease occurring to a patient en route while accompanied by a medical attendant, a similar procedure is followed.
9. See figure 2 for a graphic presentation of the above procedure.
1
TM 12-240
1 Jan 45
INITIAL NOTIFICATIONS REQUIRED FOR
FIG. 2
DOCUMENT
TROOP TRAIN COMMANDER
NEAREST ARMY POST
COMMANDING GENERAL
SERVICE COMMAND
SECTION 2. DECEASE OCCURRING ON TROOP TRAINS - INITIAL NOTIFICATIONS REQUIRED.
TELEPHONE CALL
TO
UNDERTAKER
TELEPHONE
TELEPHONE CALL AUTHORITIES
TO
LOCAL HEALTH
- Telepnones to local undertaker to arrange for placing the deceased in an undertaking parlor.
TELEPHONE
- Telephones local healtn authorities notifying them of the deceased personnel.
TELEPHONE CALL
TO
NEAREST ARMY POST
TELEPHONE I M ______________I
TELEPHONE
If train commander knows of nearby Army InstaI lation, ne will telephone requesting responsible personnel.
- Receives notification.
- Designates responsible personnel to take charge of deceased, make disposition, and notifications required.
TELEPHONE CALL (IF REQUIRED)
TO
SERVICE COMMAND
TELEPHONE
I— >
TELEPHONE |
TELEPHONE CALL TO (IF REQUIRED)
NEARER ARMY POST
- If train commander does not know of nearby Army Installation, telephones to CG of Service Command, in which decease occured requesting designation of nearby Army Post or responsible personnel from Hq to take charge.
- States name and address of undertaker caring for deceased.
- Receives notification.
- Designates nearby Army Installation to take charge or sends responsible personnel from C.G. to take charge.
- Notifies troop train commander who will take charge.
TELEPHONE
TELEPHONE
- Receives notification to take charge of deceased.
TELEGRAPH
TO
THE EMERGENCY ADDRESSEE
- If necessary and if responsible personnel is not sent from Hq, telephones nearest Army Post to take charge.
- States name and address of undertaker.
- Acts without delay.
TELEGRAPH
TELEGRAPH
TO
THE ADJUTANT GENERAL-
- Notifies emergency addressee of decease stating name and address of the undertaker and of the nearest Army Post or CG, Service Command, who will arrange disposition of deceased.
TELEGRAPH
TO
NEAREST ARMY POST
- Prepares and sends wire to the Adjutant General.
TELEGRAPH
TELEGRAPH
- Receives notification of disposition to be made of deceased, See sections 4,
8
1 Jan 45
TM 12-240
DECEASE OCCURRING ON TROOP TRAINS
CONTRACT UNDERTAKER OR EMERGENCY ADDRESSEE
nnaDTFDUACT» L0CAL HEALTH *UTHM,TIE$ OR the ADJUTANT GENERAL
VUAKitKMAoitK DESIGNATED FUNERAL DIRECTOR
_________________ NOTE I. - The deceased should not be moved (across state, and in some states, county lines.
- The troop train commander will leave the deceased at the nearest train stop with undertaking - Receives call. facilities.
- Arranges to obtain the remains of - The !er''l« !;ec°rd and al‘led
the deceased Papers wl11 be del lvered to the re"
sponsible military personnel desig-_________________ nated to take charge so that it will I be possible to make proper notifi-
cation and forward records as shown in subsequent sections,
- Receives notification of deceased personnel.
NOTE 2. - If decease occurs to a patient enroute being escorted by a medical attendant the same procedure will apply, the medical attendant acting as the troop train commander shown here. The medical attendant will also inventory the effects of the deceased. The attendant will notify proper authorities of destination of the patient of his death.
MmAoaamBHaiMHaMaBB telegraph
- Emergency addressee receives noti- _________________
fication of decease. k
TELEGRAPH
- Receives.
- Uses as a basis for preparing re-—--------------- port of death.
- Emergency addressee or his designated funeral director wires what disposition is to be made of deceased and who is authorized to make burial arrangements.
9
1 Jan 45
10
TM 12-240
CHAPTER 4
ADMINISTRATIVE PROCEDURE FOR DECEASE IN
U. S. ARMY HOSPITALS
10. A Hospital Report of Death, WD AGO Form 52-9, and the Standard Certificate of Death of the State Department of Vital Statistics will record along with the notification to the commanding officer, when required, all the administrative reports necessary when death occurs at a U. S. Army hospital. A complete administrative record will then be on file for reference. The file copy of the Certificate of Death, signed by the receiving undertaker, serves as the hospital’s receipt for the deceased. Another copy of the Certificate of Death furnished the undertaker serves as the release of the remains to him.
11. WD AGO Form 8-24 (old WD MD Form 52), will be prepared in accordance with current admission procedures.
12. The sections following (fig. 3) explain the reports required to dispose of the deceased; the conduct of the Summary Court; and the preparation of Report of Investigation, WD AGO Form 51, wherever these are necessary, in a U. S. Army hospital. (See figs. 4 and 5 for forms referred to in fig. 3.)
11
TM 12-240
1 Jan 45
ADMINISTRATIVE PROCEDURE FOR
FIG. 3
DOCUMENT
WARD OFFICER
CHIEF OF SERVICE
REGISTRAR OR
OR HIS DESIGNEE
ADMINISTRATIVE OFFICER
OF THE DAY
SECTION 3
ADMINISTRATIVE PROCEDURE WHEN DEATH OCCURS IN A UNITED STATES ARMY HOSP I TA L
Preparation and Disposition of Hospital Death Re port
DEATH REPORT WARD
DEATH REPORT |
- WARD - CHIEF OF SERVICE^
DEATH REPORT
- WARD - CHIEF OF SERVICE - REGISTRAR________
HOSPITAL REPORT OF DEATH W.D., A.G.O. 52-9 ' THIS REPORT CONTAINS THE FOLLOWING - WARD REPORT - RECORD OF AUTOPSY - ADMINISTRATIVE REPORT - INSPECTION OF REMAINS
- Prepares ward report.
- Forwards immediately to the Chief of Service or his designee.
- Performs and supervises professional duties.
- Checks and makes necessary changes, and approves.
- If Commanding Officer Requests autopsy be performed on military personnel, does so, AR 600-550.
- Authority for autopsy from next of kin not required for military personnel, AR 600-550.
- Prepares record of autopsy.
- Starts administrative action on basis of report.
- Enters each action on death report.
- Holds report in suspense until used to record inspection of remains.
---ITEAFH REPORT---- - WARD - CHIEF OF SERVICE - REGISTRAR - inspection
- Files completed report.
TELEPHONE
- Telephones to contract undertakers or quartermaster if there is no contract undertaker, to arrange for preparation of remains for burial.
Preparation and Disposition of the Certificate of Death when Coroner Is Not Required to Sign Certificate
CERTIFICATE OF DEATH
STATE HEALTH DEPARTMENT FORM FURNISHED BY U.S. BUREAU OF CENSUS
| 1 CERTIFICATE
1 2 CERTIFICATE
U [3 CERTIFICATE hg
4 I CERTIFICATE 1 OF DEATH
- Completes preparation of certificate of death.
CERTIFICATE
CERTIFICATE OF DEATH
- Forwards copy 3 to U.S. Census Bureau.
- Files copy as receipt for deceased from undertaker.
Preparation and Disposit ion of. Cert i f i c ate of Death when Coroner I s
CERTIFICATE OF DEATH STATE HEALTH DEPARTMENT FORM FURNISHED BY U.S. BUREAU OF CENSUS
CERTIFICATE In
CERTIFICATE
CERTIFICATE
U CERTIFICATE
5 CERTIFICATE OF DEATH
- Normally prepares certificate for coroner. - If requested by coroner to
NOTE 3 - If coroner is unduly delayed In signing certificate of death (over 24 hours), Commanding Officer of make changes, does so.
i ■ CERTIFICATE hg
hospital is authorized to sign. CERTIFICATE | r
|3 CERTIFICATE 1
J 4 | CERTIFICATE Si OF DEATH F
- Receives copies 1-4 frc coroner. - Forwards copies 1-3 to laboratory service to rema ins. - Forwards copy 4 to cens oureau. m e u lease 8.
3 CERTIFICATE OF DEATH
- F i les. - See sections 4, 5, 6 , 7
12
1 Jan 45
TM 12-240
DECEASE IN U. S. ARMY HOSPITALS
LABORATORY SERVICE PERSON AUTHORIZED TO SIGN DEATH CERTIFICATE
CONTRACT
UNDERTAKER OR
QUARTERMASTER
—DErnriOTin— - WARD
- CHIEF OF SERVICE - REGISTRAR
- INSPECTION
- At t ime of inspection of remains the surgeon or h is des ignee and the quartermaster or his designee sign inspection of remains report or refuse to s i gn.
- Return report to reg-
LOCAL CORONER
(IF NECESSARY)
STATE HEALTH
DEPARTMENT
UNITED STATES
CENSUS BUREAU
NOTE I
- Commanding Officer of Army hospital in the United States will notify the nearest relative by telephone of a patient in a critical condition as out Iined in AR 40-590.
NOTE 2
- The Ward officer will notify the Chaplain of the appropriate faith of patients In a critical condition prior to decease if possible and in all cases of decease.
TELEPHONE
Arranges to move de ceased and prepare remains for burial
CERTIFICATE |
2 CERTIFICATE OF DEATH I
CERTIFICATE
2 CERTIFICATE
RETA IN
CERTIFICATE OF DEATH
CERTIFICATE OF DEATH
- Forwards copy I to State Health Dept.
- Retains copy 2 as his record and release.
- Prepares statistical data.
- Uses for inspection purposes.
CERTIFICATE-—I
CERTIFICATE OF DEATH
- Prepares statistical data*
- Uses for inspection purposes*
- Signs el I copies
- Sends I 4 2 to undertaker.
t Obtains signature of undertaker as receipt for deceased on copy i|.
CERTIFICATE ba
CERTIFICATE U
3 CERTIFICATE OF DEATH
- Forwards copies I & 2 to undertaker.
- Obtains signatures of undertaker as receipt for deceased on copy 3*
- Forwards copy 3 to
2 CERTIFICATE
OF DEATH
- Forwards'copy I to State Health Dept.
- Retains copy 2 as his record and release.
1 CERTIFICATE
12 CERTIFICATE 13 C.FRTf Flf.ATF
Hr CERTIFICATE
J CERTIFICATE 1 OF DEATH
- Approves. - Signs all copies. - Retains copy 5.
3 b
CERTIFICATE 1
OF DEATH
Prepares statistical
data.
CERTIFICATE OF DEATH
622845 0 - 45 -2
13
TM 12—240
1 Jan 45
HOSPITAL REPORT OF DEATH
WO AGO FORM 52-9
HOSPITAL REPORT OF DEATH _________AR 600-550______ _________WARD REPORT_____
1. LAST NAME - FIRST NAME - MIDDLE INITIAL Doe, John J. 2. ARMY SERIAL NUMBER 2,468,109 3. GRADE Pvt. 4. WARD 24
5. DIED (Hour - Day - Month - Year) 1700 24 July 1944 6.CHAPL. NOT IF. 7. RELIGION P
YESX NO
8. NAME, ADDRESS, AND RELATIONSHIP OF PERSON TO BE NOTIFIED • Mr. Thomas C. Doe, 27 Hillside Ave,, Woodstock, Conn.
9. NAME, ADDRESS, AND RELATIONSHIP OF RELATIVE OR FRIEND PRESENT AT DEATH None
10. DIRECT CAUSE OF DEATH Peripheral vascular collapse, severe secondary to item 2 he low 11.LINE OF DUTY 12. MISCONDUCT
YES Ui NO ide ten YES lined NO
13. CONTRIBUTORY CAUSE OF DEATH Brain, Laceration of, Severe, accidentally incurred when soldier was hit by truck at 2200, 23 July 1944, Ft. Dix, N.J. 14.L 1 NE OF DUTY 15. MISCONDUCT
YES ' Uni NO Leterm: YES ned NO
16. PRINCIPAL FINDINGS OF OPERATION (If none performed, so state) Subdural hematoma, left, extensive. Brain, laceration of, diffuse severe. Operation performed O1JO', 24 July 1944 17. INVESTIGATING OFF. REQUIRED
YES X NO
18. MEDICAL OFFICER IN ATTENDANCE (Signature only) 19. CHIEF OF’MEDICAL OR*SURGICAL SERVICE (Signature only) (^Delete one L- * W-C-.
RECORD OF AUTOPSY
20. AUTOPSY ORDERED BY (Signature of C.O, or his Desig nee ) ^7. c. 21. DATE 24 July 1944
22. PRINCIPAL FINDINGS AT AUTOPSY (If none performed, so state) Subdural Hematoma, left extensive. Brain, laceration of, diffuse, severe. Skull, fracture of, multiple, compound, decompression, operative, left.
23. AUTOPSY PERFORMED (Place and Date) 24 July 1944 Tilton Gg, Ft, Dix, N.J. 24. AUTOPSY PERFORMED BY (Signature only) c^-, WC-
VE REPORT
ADM I N I STRAT'
25. ACTION TAKEN BY REGISTRAR-ADMIN. OFF. OF DAY (AR600-500) HOUR DAY MONTH YEAR INITIALS OF RESPONS.OFF.
k. Telegram to emergency addressee 17^0 24 .Tulv 1Q44 TJH
B. NOTIFICATION TO AUTOPSY SURGEON 1750 n ft TJH
C. TELEGRAM TO ADJUTANT GENERAL 1730 ft n TJH
0. NOTIFICATION TO COMMANDING OFFICER 1730 n ■ TT ” "H ' TJH
E. NOTIFICATION TO RED CROSS 1730 n n TJH
F. NOTIFICATION TO INFORMATION OFFICE 1730 TJH
G. NOTIFICATION TO UNDERTAKER 1900 n TJH
H. NOTIFICATION TO TRANSPORTATION OFFICE 0800 25 n "H ■ HAP
1. NOTIFICATION TO QUARTERMASTER (Supply) 1900 24 T! ■ TJH
J. OTHER (Specify) 0«30 ^5 HAP
26. REMARKS Pvt Fobert N. Hamill, J 426 028 is to be burial escort
INSPECTION OF REMAINS
27. IN COMPLIANCE WITH AR 40-590, 1 CERTIFY THAT THE REMAINS WERE INSPECTED j ^7 • ■
AFTER EMBALMING, AND AGAIN, -BODY WAS CLOTHED AND PLACED IN COMPANY WITH THE CONTRACT 1 NG OFF 1CER AFTER THE IN THE CASKET AT (Place of inspection) *
28. SIGNATURE OF INSPECTING OFFICER- FOR SURGEON 29. SIGNATURE OF INSPEC TING OFFICER-FOR QUARTERMASTER
^7 .C • >17
INSTRUCTIONS: Ward Officer will prepare items 1 - 18, Chief of Service will sign item 19. Form will then
be forwarded to Registrar o r Administrative Officer of the day for necessary action without delay.
Prepare in one copy only. ' K L . ■!, » A Use of ink or indelible pencil authorized. Print or type entries.
Figure 4.
14
1 Jan 45
TM 12-240
DEPARTMENT OF COMMERCE Bureau or the Census
CERTIFICATE OF DEATH
STANDARD CERTIFICATE OF DEATH
State of.
.llew...J.eraay.
State File No. .
Registrars No.
I. PLACE OF DEATH:
(a) County -Byrling^onj,. NewJHanpyer _Towns.hip
(6) City or town_______________________________________________________
(If outside city or town limits, write RURAL)
(c) Name of hospital or institution:
_________T111on. General _ Hosp it al__________________________________
(If not in hospital or inetitution. write street number or location)
(d) Length of stay: In hospital or institution_________________________
In this community 1 1
2. USUAL RESIDENCE OF DECEASED:
(o) State New, Jersey,,,, (t) County. Burlington
(C) City or town... .Fort. Dix,. New .Jersey._
( 26 Jul 44
S- GA
18. (a) Signature of funeral director..ilQnfia.Eunftml.. Jlrecte ^d) Did injury occur in or (j) Address____Zcenioxi^.N^J..
22. If death was due to external causes, fill in the following:
(a) Accident, suicide, or homicide (specify)-------------
(6) Date of occurrence_July__1^4U------------------------
(c) Where did injury occur? .....Fort. DiX. NeW. JerSey__
(City or town) * (County) (State)
about home, on farm, in industrial place, in public
place? Military Reservation____________________
While at work?,____... wrijurytoK.aCCident
23. . - — (M. D. or other)-----
Address __ Burlin^QI^O.UIlty..ComerDate signed -Z-2U
U. S. GOVERNMENT PRINTING OFFICE 10—13403
have received the remains of the above in
Figure 5.
15
1 Jan 45
13
TM 12-240
CHAPTER 5
IMMEDIATE NOTIFICATIONS REQUIRED FOR AIL DECEASED PERSONNEL
13. An Initial Report of Death, WD AGO Form 52-5, is provided as a simple means of making the immediate notification required after the surgeon has reported the death of military personnel to the commanding officer of a post, camp, station, or air field. Items A through Z, Part 1 of Form 52-5, are the basis of the telegraphic report to The Adjutant General. Part 2, when completed with necessary information, is the request and basis for any orders required to ship the deceased, with a burial escort, to the place of interment. Part 3 is the authority and the orders for a summary court officer, where required. Part 4 is the authority and the order for the investigating officer, where required to conduct investigations.
14. The preparation of these Parts in one operation makes it possible to give complete data to all interested
agencies with a minimum of delay after the death.and without waiting for publication of special orders. It is not necessary for a summary court officer or for an investigating officer to wait to receive his part of the report. Instead, he may proceed with the necessary arrangements and receive the orders at a later date.
15. A letter of sympathy is sent to the nearest relative over the signature of the commanding officer of the post, camp, or station. (See fig. 9 below for suggested form of letter of sympathy. The other immediate notifications, and procedures for their use, are presented in figures 6, 7, 8, and 10.) The letter of sympathy mentions that dependents of the deceased and their household goods under certain circumstances may be moved to their home of record. Authority for this is prescribed in AR 55-120 and AR 55-160.
17
TM 12-240
1 Jan 45
IMMEDIATE NOTIFICATIONS REQUIRED
FIG. 6
DOCUMENT
SURGEON
IMMEDIATE COMMANDING OFFICER
SUMMARY COURT OFFICER
SECTION 4 - IMMEDIATE NOTIFICATIONS. WITHIN TWENTY FOUR HOURS UPON DECEASE OF PERSONNEL SUBJECT TO MILITARY AUTHORITY
NOTIFICATION BY SURGEON (LETTER, TELEPHONE CALL OR OTHER FORM OF NOTIFICATION)
TELEGRAPH MESSAGE TO EMERGENCY ADDRESSEE
COMMERCIAL WIRE TO EMERGENCY ADDRESSEE
REPORT OF DEATH WO AGO 52-5
I I NOTIFICATION 1—
|2 NOTIFICATION
4 P 1 NOTIFICATION
U NOTIFICATION W' ■
- Prepares notification of - Collects and inventories
decease for immediate effects. (See Section 6)
Commanding Officer and - Drops soldier from morn-
for Commanding Officer of ing report.
post, camp or station. - Determines who will be
- Telephone or other ad- burial escort.
vance notification will
be confirmed by written notification.
- Uses a oasis for authority to act as summary court officer, See section 6.
TWX TO THE ADJUTANT GENERAL
SECTION 5 - PREPARATION AND DISPOSITION OF LETTER OF SYMPATHY
LETTER OF SYMPATHY
18
1 Jan 45
TM 12-240
FOR ALL DECEASED PERSONNEL
INVESTIGATING
OFFICER
AGO 52-5
- Uses as a basis for author ity to conduct an investigation if required. See Section 8„
COMMANDING OFFICER
NOTIFICATION 1 ♦ by s- e-
- Receives notification surgeon. - Obtains all other nece sary data avai lable, - Uses as a basis for pr par at ion of following not if icat ions.
1 TELEGRAPH |
2 TELEGRAPH e a 1 ss
- Prepares telegraph to th emergency addressee, reporting decease, requesi ing designation of funer director, name and addre of person designated to incur funeral expenses, and stating burial expenses allowed.
1 AGO 52-5 ►F
2 AGO 52-5
AGO 62-5 |
* AGO 52 5 1
F ♦ J AGO 52-5
Prepares, signs, and di tributes Form 52-5. s —
fl - Pre of re - The ter or*5 rec rea - No or dec dut mis - The a o by wj 1 in men due - The who men LETTER |i
2 LETTER OF SYMPATHY r »r
pares and ma iIs lette sympathy to nearest ative or next of kin. purpose of this let-of sympathy is to ex ss warmest sympathy t ioient at time of be-vpment. reference will be mad inferred as to whethe eased died in line of y or due to his own conduct. letter wj11 specify ersonal affairs offic name and address, who 1 aid the next of kin obtaining any entitle ts, as arrears of pay h im. letter will spec ify will arrange shi p- of effects.
SIGNAL CENTER
EMERGENCY ADDRESSEE OR NEAREST RELATIVE
THE ADJUTANT
GENERAL
N Extreme care will be tak preparing all notificati OTE 1 en in obtaining data and ons.
Report of death, WD AGO not required (AR600-550 OTE 2 Form 52, Nov. 1943 is -
TELEGRAPH
Receives. Uses as a basis to send commercial wire to Emergency addressee.
WIRE L
Sends commercial wire to emergency addressee.
AGO 52-5
Rece ives. Uses as a basis for sending TWX to TAG.
Sends TWX to TAG. Message will be sent in same sequence as on Form 52-5.
WIRE
Receives notification decease.
k 1 LETTER OF | SYMPATHY
of
- Uses as a basis for preparing official War Department Report of Death.
Nearest relative, or next of kin, receives letter of sympathy.
19
TM 12-240
1 Jan 45
NOTIFICATION BY SURGEON
(Forwarded in all cases of death; serves as confirmation in some instances)
FROM: Commanding Officer Tilton General Hospital Ft. Dix, New Jersey DATE TO: COMMANDING OFFICER Ft, Dix, New Jersey
NOTIFICATION BY SURGEON SEC. PAR. 2, AR 600-550
1. LAST NAME, FIRST NAME, MIDDLE NAME. Doe, John James 2. ARMY SERIAL NO. 2U681O9 3. GRADE Pvt.
R. COMPANY, REGIMENT, SEPARATE BATTALION OR SIMILAR UNIT. Co. A, 181st Inf., Ft. Dix, N.J. 5. IF UNASSIGNED STATE ARM OR SERVICE
6. DATE, PLACE ANO CAUSE OF DEATH. 2J July 19^, Ft. Dix, N.J., Brain, Laceration of, severe, accidentally received when soldier was hit by a truck while pushing two members of Army Nurse Corps to safety.
7- DID DEATH OCCUR IN LINE OF DUTY? Undetermined 8. WAS DEATH DUE TO DECEASED'S MISCONDUCT ? Undetermined
9. ACCEPTED APPLICANT FOR ENLISTMENT ? No 10. DISCHARGED ENLISTED MAN ? No
11. IF A CIVILIAN EMPLOYEE, STATE ARM OR SERVICE OR BUREAU BY WHICH EMPLOYED.
12. AUTOPSY REQUIRED ? Yes 13. INVESTIGATING OFFICER REQUIRED ? Yes
IN. ADDITIONAL DATA OR REMARKS. Investigation required due accident causing soldier's death. Z^OTra^URNBULL Colonel, MC Commanding
REPRODUCE LOCALLY DISTRIBUTION SURGEON TO COMMANDING OFFICER.
Figure 7.
20
u)
1 Jan 45 TM 12-240
TELEGRAM TO EMERGENCY ADDRESSEE
(WD AGO FORM 801)
WAR DEPARTMENT |
MESSAGEFORM Dote 24 July i.9Li- ■
Commercial Wire
File No. ....123----------- Telephone No. .532.___ I
Office of origin .KQ.adquartera____________________________ ________ ____ .£DCG._____ I
(Ann ,,r servloe) ’ ' (Dl’vfaton)"' (Bradi) (SMtlon)'.. '(Symbol) I
Address__________Eei±„Di.X^..New .Jersey I
________ PRECEDENCE M
iO: ~ I WIRE OB RADIO ESSENTIAL MUJTART MAI.
MR. THOMAS C. DOE UrgentC^ftA.jlFlW Airmail M
27 HILLSIDE AVENUE Priority_______ Special delivery_____ZZH
WOODSTOCK, CONN. _______________________________
। . Deferred----- Registered.____________
|_______ ______________________________| Week end
Initial of officer
Any message not X'd for precedence assigning pnced,n» ■ will be sent “Deferred."
MESSAGE:
I REGRET TO INFORM YOU THAT YOUR SON, PRIVATE JOHN JAMES DOE HAS
DIED DUE TO INJURIES RECEIVED IN A MOTOR VEHICLE ACCIDENT AT FORT
DLK NEW JERSEY ON JULY TWENTY THIRD STOP LETTER FOLLOWS STOP THE
DECEASED IS NOW AT TILTON GENERAL HOSPITAL STOP KINDLY WIRE COLLECT
THE NAME AND ADDRESS OF AN UNDERTAKER TO WHOM YOU WISH HIS REMAINS
SHIPPED AT GOVERNMENT EXPENSE STOP FIFTY DOLLARS WTT.T. BE AT,TOWED FOR
BURIAL EXPENSES STOP KINDLY INCLUDE IN YOUR WIRE THE NAME AND ADDRESS
OF A PERSON DESIGNATED TO INCUR THESE BURIAL EXPENSES STOP
MY DEEPEST SYMPATHY IS EXTENDED TO YOU AND MEMBERS OF THE DECEASED
FAMILY AT THIS TIME END
MADISON PEARSON
BRIGADIER GENERAL,U.S.A. COMMANDING i
W. IX, A. U. O. Form No. 801
/A/
Figure 8.
21
TM 12-240
1 Jan 45
LETTER OF SYMPATHY
Headquarters
Ft. Dix, New Jersey 24 July 1944
Mrs. Thomas C. Doe 2/ Hillside Avenue Woodstock, Connecticut
My dear Mrs. Doe:
It is with regret that I confirm the recent telegram sent to Mr. Thomas C. Doe informing him of the death of your son, Private John J. Doe, 2 468 109, Infantry.
Your son died as a result of injuries incurred while saving the life of two members of the Army Nurse Corps. Seeing a large truck, out of control, about to run down the two nurses, he immediately ran to their aid, pushed them to safety, and was struck by the oncoming truck. His death was Instantaneous. I hope his courageous act may be of solace to you.
Captain H. A. Campbell, Personal Affairs Officer, Ft. Dix, New Jersey, has collected your son's personal effects and has forwarded them to you at the address. If Captain Campbell can be of help to you in any manner, such as in making settlement of accounts, aiding you in applying for pensions or arranging to move the deceased's dependents and household goods to their home, please communicate with him and he will furnish you any assistance possible.
My heartfelt sympathy is extended to you and other members of your family in your bereavement.
Sincerely yours
Madison Pearson
Brigadier General, U.S.A.
Commanding
22
Figure 9.
1 Jan 45
TM 12-240
INITIAL REPORT OF DEATH
(WD AGO FORM 52-5)
INITIAL REPORT OF DEATH
POST, CAMP, STATION, OR HOSPITAL ORIGINATING REPORT
Tilton General Hospital________________________
ADDRESS
Ft, Dix, New Jersey
INITIAL REPORT OF DEATH
_________AR 600-550
A. LAST NAME - FIRST NAME - MIDDLE NAME
24 July 19^4
B. ARMY SERIAL NO.
C. GRADE
Doe, John James
D. HOME ADDRESS
27 Hillside Avenue, Woodstock, Conn.
G. PLACE OF DEATH
Tilton General Hospital, Ft. Dix, N.J.
STATION OF DECEASED
H. CAUSE OF DEATH
2 468 109
E. ARM OR SERVICE
Inf.
Peripheral, Vascular Collapse
181st Inf, Ft. Dix, N.J.____________________
m. emergency addressee (name, relationship a address)
Mr. Thomas C. Doe, Father
27 hillside Avenue
Woodstock, Conn,_________________________________
N. BENEFICIARY (NAME, RELATIONSHIP A ADDRESS)
Mrs. Thomas C.^-Doe
27 Hillside Avenue
Woodstock, Conn. ,
P. INVESTIGATION REOU I RED
K.DATE OF ENTRY ON CURRENT ACTIVE SERVICE
10 May 1942
W.ACCEPTED APPLI- X. CANT FOR ENLISTMENT
IN LINEOF DUTY
"yes Tno Uncle tgrrnined. DISCHARGED
ENLISTED MAN
OWN MISCONDUCT
"yes [no
Undete|fmined
S.WAS DECEASED ON ACTIVE DUTY STATUS
AUTHORIZED ABSENCE
Z.DATE EMERGENCY
ADDRESSEE NOTIFIED
24 jul 1944
DATE INVESTIGATING OFFICER APPOINTED
25 Jul 1944
Pvt,_________
F. DATE OF Bl RTH
1 May 1911
I. DATE OF DEATH
24 July 1944
.. LENGTH OF SERVICE
___FOR PAY PURPOSES
YEARS I MONTHS)
2 2
DAYS
15
0. DATE BENEFICIARY
DESIGNATED
U. IN FLYING PAY
_______STATUS
yes Tno
X
11 June 194-2
Y. IF PERMANENT CIVILIAN EMPLOYEE (AR 600-500) REPORT BUREAU
No___________________________________________
NAME, SERIAL NUMBER AND GRADE OF SUMMARY COURT OFFICER
James Dill, Major, Inf, 0 - 225954
DESTINATION OF REMAINS OF DECEASED AND FUNERAL DIRECTOR DESIGNATED TO MAKE BURIAL
J.C. Me Gill, Undertaker, 408 South Main St, Woodstock, Conn.
NAME, GRADE AND SERIAL NUMBER OF BURIAL ESCORT /
DATE SUMMARY COURT OFFICER
APPOINTED
24 Jul 1944
Robert N-. Kay, 5 426 028, Pvt MD'
NAME, SERIAL NUMBER AND GRADE OF SUMMARY COURT OFFICER
H. A. Campbell, Captain, Inf, 0 - 426-595
ADDITIONAL DATA AND/OR STATEMENT
aa. Death not due to military operations or training.
commanding Madison Pearson
____________Brigadier General, USA
INSTRUCTIONS: Prepare original PART ‘ - -■
PART
PART PART
PART
5
V,OTHER PAYSTATUS (specify below) "yes Tno _________L_x
(Items A-Z) To Signal Center for wire to the Adjutant General, Casualty Branch, Washington, D.C. Use letters to key any missing information.
Held in suspense until all required information entered and then sent to Personnel Section to prepare special orders for disposition of deceased.
To Summary Court Officer, if required - authority and order to conduct Summary Court.
To Investigating Officer, if required - authority and order to conduct investigation.
W.0..A.G.9. FORM NO. 52-5 1 August 1944
Figure 10.
23
1 Jan 45
16
TM 12-240
CHAPTER 6
DISPOSITION OF DECEASED PERSONNEL
16. Commanding officers will take prompt action to see that the disposition of the deceased is accomplished without undue delay. If there are any circumstances which may delay the shipping of the deceased to the
point of interment, the commanding officer is authorized to send notification of this delay to the emergency addressee or the person designated to arrange for the burial.
25
TM 12-240
1 Jan 45
FIG. 11
DOCUMENT
DISPOSITION OF
IMMEDIATE COMMANDING
OFFICER
PERSONNEL SECTION
COMMANDING OFFICER
SECTION 5 DISPOSITION OF DECEASED AND NOTIFICATIONS REQUIRED
PROPERTY ISSUE SLIP WD AGO 446
TELEPHONE
TELEPHONE
REPORT OF DEATH WD AGO 52-5
SPECIAL ORDERS
TELEGRAPH TO EMERGENCY ADDRESSEE OR HIS DESIGNATED FUNERAL DIRECTOR
COPIES OF TELEGRAPHIC ADVICE ON DISPOSITION OF DECEASED
- Prepares Property I
and flag.
TELEPHONE
- Receives telephone notification of disposition to be made of deceased.
- Appoints burial escort by givino name, orade, and serial number.
- Telephones advance notice to transportation office
AGO U46
TELEPHONE
AGO 446
AGO 446
AGO 52-5
telegram 1. d b
deceives telegram an uses as basis for su seouent act ions.
TELEPHONE
Telephones immedi'ate commanding officer for burial escort from deceased's organ izat ion.
Enters name as shown below.
$ SPECIAL UHGLKu [ 6 SPECIAL ORDERS |
SPECIAL ORDERS
Furnishes two copies to burial escort.
Sends burial escort to
arranoe transportation.
• Receives 52-5 and uses as a basis for special orders. - Preparation of SO required if r“mains are to be shipped with burial escorts, Contains data.
I Sers )ERS HUI II - ORDERS I
IAL ORDERS | ;cial orders'! I ■ JECIAL orders! Ml IPECIAL ORDERS
SPECIAL ORDERS h|J
11
SPECIAL ORDERS I'y.
TELEGRAPH M
7--------
TELEGRAPH
- Sends commercial telegraph to emergency address or designated funeral director stating time, date, and raiI road on wh i ch deceased will arrive. x-- Arranges for burial party to leave promptly.
- Notifies contract undertaker time deceased must be shipped.
NOTE 2
- Prepares and distributes on set of appropriate SO.
- Contains data oh investigating office, summary court, destination of remains, burial escort, and person authorized to incur burial expenses.
- Commanding officer will advise burial escort that if a color guard is requested he will contact nearest army post on arrival and arrange for color guard.
- If this is impractical contact America! Legion, Red Cross, or Beterans of Foreign Wars. Any of these organizations will aid in providing a color guard for the funeral.
- Pulls 52-5 from suspense file.
- Enters name, grade, and serial number of burial escort.
- Enters name, grade, and serial number of summary court officer.
- Enters name, grade, and serial number of investigation officer, if investigation required.
- Enters name and address of person authorized to incur burial expense.
- Enters destination of deceased.
Posts on Bulletin Board tor Enters in Daily Bu 1-
Jo Investigating Officer ( If Required)
COPY-TELEGRAM |
COPY-TELEGRAM
If EA designates person authorized to incur burial expenses makes two copies of telegram and forwards to finance office.
26
1 Jan 45
TM 12-240
DECEASED PERSONNEL
EMERGENCY ADDRESSEE FINANCE OFFICER QUARTERMASTER TRANSPORTATION OFFICER OR HIS
DESIGNATED FUNERAL DIRECTOR
AGO RR6 | NOTE I
rj------ --------K
- If imoossible to locate emergency addressee, nearest rela-
L MM ^6 I tiVe, or next of kin bury deceased at Dost or as designated
I by Quartermaster.
- If after a reasonable time he is not claimed the deceased
- Fills property issue slip. 's entitled to be buried in a National Cemetery if died
- Furnishes complete clean and *n l’ne °f duty AR 30-1810, WO Cir 325, 1944.
serviceable uniform and an ---------------------------------------------------------
internment flag without charge against deceased.
- AR 30-1820, AR 30-1830 and
AR 260-10. ------------------k
■■■■■■■■■■■■■■■ ■■■■ TELEGRAM
- Emergency addressee or his designated funeral director telegraphs disposition to be made of deceased and name and address of person authorized to incur burial expenses.
telephone
- Receives advance notice of shipment of decease with burial escort to destination,
► | 1 SPECIAL ORDERS D
________ R I
^^^>1-' SPECIAL ORDERS ■ L SPECIAL ORDERS
I, SPECIAL ORDERS I
- Arranges transportation for deceased and burial escort. Supports payment of burial expenses and issuance of rations to burial escort.
M TELEGRAPH
- Receives notification of arri-__________________ val of deceased accompanied by ICOPY-TELEGRAM | escort.
—---------------“-k - This message is normally re-
I I ceived by designated funeral
COPY-TELEGRAM Ik director or if not designated
■ B to emergency addressee.
- After receiving certificate of expenses incurred mails check not to exceed $50.00. See AR 30-1830.
CHECK I |
J ■■■ aM^ check
- Uses to issue check to person
designated to incur burial - Receives check of not over $50.00
expenses. | | for bur ial expenses.
21
TM 12-240
1 Jan 45
PROPERTY ISSUE SLIP (WD AGO FORM 446)
____________________________ PROPERTY ISSUE SLIP____________________________________________ FL
To: Lt. Col. J. A. Fitzpatrick, QM I. ttf»ofi»u. 1^" |£3 I iL
For: (Onrenitation unit) Initial ni^nt Memo Memo '
John J. Doe, 2 468 109, Pvt, Decease!--------------------------7—
Stock No. T Nomenclature ]PTnlt
Flag, internment I
Trousers, wool, od I
Shirt, cotton, khaki I
Necktie, cotton, tan
Coat, wool, od
Undershirt, cotton I I ■
Shorts, cotton ।
Socks, cotton, tan, pair I
Insignia, collar, U.S.' ।
Insignia, collar, Inf., U.S. I
----- A^.. 4 o 1 41- a
Issuance or acceptance of quantities shown in “Action" For the Commanuing Officer: z x?
column is authorized. Items marked "Ext” will be ordered. (Date) z7 zX?
Zeroed items will be available on the dates indicated hereon. __ n T+nAsn2/
When received, items will be issued on presentation of this slip. _25 Julv , 1944_ Lt. QMC. 4
Inquiries must refer to No. Orfanitoiiou Ouppio Officer._
LS -~Z / Quantities shown In “Action" column have been received.
- Jnl^------------------------ '■ j“Ly--------------------------------'IM rf-GL
____-------------------act saw Suppit Officer. _________________ _ Authorized Repraentaliee. I
W.D., AOO Form 448—o Au'' 1
wi‘ag° 54 3, f — Tl L II AGO 54 ■■MM
ttU I p If- ..2.
fl - Forwards to C.O. for approval, fl - SIgns copy I.
BBHMMHMHHMMiMMHHi - to
C *-h?n Leflal Representative or Widow, or Next of Kin is Not Known, "Commanding Officer Shall Direct a
EFFECTS ■■■^^M
EFFECTS OF. DECEASED L.^—J^^^fl I EFFECTS 5ELL
- Collects effects. ■ |l AGO 54
- Delivers to summary court ■ |J r?-----
off icer along with form 54. ■ | , .*GJ?-.-5Z_
n---------------I L H _ "
1 AGO 54 [M L X || p p too 54 ■ ” L AGO 54 Mk
INVENTORY OF EFFECTS AND REPORT OF SUM- II [3--------7C77------
MARY COURT WD AGO 54 | i----*G0 5______i i i.l
mm I 4 AGO 54 L* [I |g ■ —” Receives effects and Form 54.
H I - Verifies inventory -and signs re-
|^ AGO 54 ^^^k ceipt copy 4, Form 54.
- Pays local creditors, collects from debtors. Sells effects. - Inventories effects on Form 54 ’ Sel!’ MakeS a ful1 re"
(front). ’ port of 3,1 transactions on Form
54. Does not convert commercial
* PROCEEDS FROM SALE OF EFFECTS |
CASH OR CHECK
CASH OR CHECK Turns ,n funds from pr°-
----- ceeds of effects, if any.
_^n F AGO 54 I . ago 54
- Retains copy 3. ■
| - Forwards copies 1-2 to C.O. H - Approves by signing.
, ___________________________________________________________________MHI HMHHMHHHHHBHHHHHHHHHI M ~ Forwards to tag.
1 Jan 45
TM 12-240
OF DECEASED PERSONNEL
PERSONNEL SECTION FINANCE OFFICE LEML REPRESERTAT,,,E THE ADj||TANT GENERAL
OR WIDOW OF DECEASED
NOTE: - Files.
- Commercial papers, bank accounts, stocks, bonds, or negotiable instruments will not be converted into cash but forwarded to widow, legal representative, or, the Adjutant Genera I.
- Receives effects.
- If practicable signs receipt for effects.
a Summary Court to Secure All Effects" A.W, 112.
___k I effects I
n AGO 51
Up—— I, AGO 54 | ^kB
- Receives effects.
- Signs copies 1-2 Form 54 under B-"Receipient" and mails to summary court officer.
BB^ g||
- Files.
Summary Court to Secure All Effects" A.W. 112
H AGO 54 ■■k
|2 AGO 54 ________
U I 3 AGO 54 |
■■■■■^■■B■■■ “ [I p ago 54
CASH OR CHECK
- Receives funds for deposit.
- Signs copies 1-3 as receipt for funds.
QAGO 54 I
AGO 54 f
- Files cooy 2.
- Forwards copy I to Fiscal Director^
31
TM 12-240
INVENTORY OF EFFECTS, WD AGO FORM 54 (Front) (Distribution as indicated in sec. 6, Fig. 13)
INVENTORY OF EFFECTS - AR 600-550
1. LAST NAME - FIRST NAME - MIDDLE INITIAL Poe, J ohn J. 2. ARMY SERIAL NUMBER 2468109 3. GRADE Pvt 4. DATE OF DEATH 24 Jul 44
5. ORGANIZATION OF DECEASED (Ase.Rn'd) 181st Inf, Fort Dix, N. J. 6. PLACE OF DEATH Tilton GH Fort Dix, New Jersey
7. CLASS 1 EFFECTS - SA8ER, INSIGNIA, DECORATIONS, MEDALS, CAMPAIGN CITATIONS, WATCHES, MANUSCRIPTS AND OTHER ARTICLES VALUABLE CHIEFLY AS KEEPSAKES. (If necessary Class I Effects may be included and listed under 8.)
NUMBER DESCRIPTION OF ARTICLE NUMBER DESCRIPTION OF ARTICLE
1 4 ,1 Watch, wrist, Hamilton, green gold with leather strap Pictures, snapshot size Identification Bracelet, wrist, s ilver, engraved
8. CLASS II EFFECTS - MONEY, 8ANK DRAFTS, CHECKS, MONEY ORDERS, PERSONAL EFFECTS, BILLFOLD ETC.
NUMBER 1 6 1 3 1 5518.04 DESCRIPTION OF ARTICLE Wallet, leather, black coins, English, assorted Driver's license, Conn. Letters, personal, opened Check, City National Bank, Wood-stock, Conn. Coins and currency. NUMBER DESCRIPTION OF ARTICLE 4
32
____________________________________________________________________t y ENTER TOTAL AMOUNT OF CASH OR EQUIVALENT HERE ______________________________FOR USE OF IMMEDIATE COMMANDING OFFICER OF ORGANIZATION SECURING EFFECTS
9. CHECK HERE IF EFFECTS SENT TO THE EFFECTS QUARTERMASTER, ARMY VES '*• 1 CERTIFY THAT THE FOREGOING INVENTORY COMPRISES ALL THE EFFECTS OF ABOVE EFFECTS BUREAU, KANSAS CITY QUARTERMASTER DEPOT, KANSAS CITY, MO. H4MED DECEASED. .
NOTE: TO NOT SEND PERSONAL EFFECTS OF PERSONNEL DECEASED WITHIN ■---\ ________
THE UNITED STATES TO THE EFFECTS QUARTERN ASTEP.________ SIGNATURE
10. EFFECTS ARE TO BE DELIVERED OR SHIPPED IN ACCORDANCE WITH A.H. 112 NAME AND GRADE
IF EFFECTS DELIVERED TO LEGAL REPRESENTATIVE MAKE ENTRIES HERE. _ _
name Mrs Thomas C. Doe organi^o? ROank> Gapt" Tnf‘---------------------------------------
*mEss 27 Hillside Avenue 181st Inf, Ft. Dix, N.J._____________________________________
___ __ „___ ,, 12. SIGNATURE OF RECIPIENT OR SUMMARY COURT OFFICER
city ano state Woodstock, Conn. , Z> '/?
DATE DELIVERED 25 July, 1944 /V' ---
W.O.,A.G.O. FORM NO. 54 27 June 19UU THIS FORM SUPERSEDES W.D..A.G.O. FORM NO. 5U, 1 JULY 1933 WHICH WILL NOT BE USED AFTER RECEIPT OF THIS FORM.
Figure 14.
Figure 15.
33
1 Jan 45 TM ] 2—241
REPORT OF SUMMARY COURT, WO AGO FORM 54 (Back) (Distribution as indicated in sec. 6, Fig. 13)
REPORT OF SUMMARY COURT - AR 600-550
13. THE FOLLOWING AMOUNTS DUE THE ESTATE OF THE DECEASED WERE COLLECTED I
DATE AMOUNT RECEIVED FROM ———AMOUNT RECEIVED FROM
‘ ’----------------------------------------------------------------------------------------■-)
25 Jul 44 2.08 William H. Hill |<
5679625, Pvt, (<
181st Inf. •:<
: F
•________________________________________________total 2.08 [> t
14, THE FOLLOWING CLAIMS AGAINST THE ESTATE OF THE DECEASED MERE PAID t< K”
D>TE AMOUNT PAID TO DATE AMOURT PAID TO |<-
25 Jul 44 7.05 Thomas R. Robbins t< 8
5557^52, Pfc, < f#
181st Inf. |< p
_____________________________________________ total___________ 7.05 •<<
IS- OTHER TRANSACTIONS, IHCLUDIHG SALE OF EFFECTS. REPORT EACH TRANSACTION IN DETAIL CSee AR 600-550). NOTE: STOCKS, BONDS AND OTHER COBH HCIAL EATER WILL [■? [S
KT BE CONVERTED INTO CASH. HIT SENT TO THE ADJUTANT GENERAL WITH THIS RETORT IN CASE OF DOHESTIC DECEASE. FOR OVERSEAS CASUALTIES THESE EFFECTS WILL BE g. .V?
SENT 10 THE EFFECTS OUARTEHtASTER. |y |V.;
None >s. £•: L?
/^$y 11
_____________________________________________________I b
ENTER AMOUNT OF MONEY REALIZED FROM SALE OF EFFECTS HERE IN MOROS ANO FIGURES. I;. fe.
None {? Sv
———— ------------------------------------------------------------------------------------------------- |:.
RECEIPT FOR FUNDS J?
PROCEEDS OF SALE OF PROPERTY OF DECEASED MILITARY PERSONNEL (AR 600-530) f.’?
(Normally not to be used for overseas casualties under Par. 16, W.D. Circular 195, 1943. Send Check to Effects Quartermaster.) *•’ V.\*
APPROPRIATION TO BE CREDITED BY DISBURSING OFFICER AMOUNT (In vnrds and figures) DEPOSITED WITH DISBURSING OFFICER |.t
None None
DATE, ORGANIZATION AND LOCATION OF DISBURSING OFFICER SIGNATURE AMD TYPED NAME AND GRADE OF DISBURSING OFFICER fe
17. DATE APPROVED 6Y COIftAHDIHG OFFICER " 18. DATE AND LOCATION t< f‘v
25 July 1944 July 1944
Ft. Dix, New Jersey [< r<::
SIGNATURE OF COMMANDING OFFICER SIGa*TVKE OF SUMMARY COURT OFFICER —————————— |.y
TYPED NAME^^^ADE ~ TYPEo’^N^^GRADE AND ORGAN^UIOr/''^^'"^^^'^^^
Malison Pearson H. A. Campbell, Capt. Inf. £ t<:
______Brigadier General, USA_______________________ 181st Inf., Ft. Dix, N.J. |<
U. S. GOVERNMENT PRINTING OFFICE 1944 O 599883 jA |v.
: •I*!’1! • • f.r.r. • -'.M. • .* ’TT?T: •. • .T • J.’.'* -'J .*■. I r'l'T1.: • F.T • • I'.I. • F. i I'T . ■■ • ■■rT^ • i r»f. a । i. .W । mmw j-X>
1 Jan 45
20
TM 12-240
CHAPTER 8
PREPARATION AND DISPOSITION OF FINAL PAPERS
20. a. It is essential for The Adjutant General to receive the service records and allied papers of a deceased enlisted person as soon as possible after a death.
b. Allotment offices must receive prompt notification of discontinuances of allotments or allowances in order that issuance may be terminated.
c. It is necessary that the Final Payment Roll be received in the Office of Special Settlement Accounts, Office of the Fiscal Director, New York, N. Y., without delay in order that adjustment of any arrears of pay may be properly made.
21. Figures 15 and 17 illustrate how the above may be readily accomplished.
35
TM 12-240 1 Jan 45
PREPARATION AND DISPOSITION
FIG. 16
36
DOCUMENT PERSONNEL SECTION IMMEDIATE COMMANDING
OFFICER
SECTION 7 PREPARATION AND DISPOSITION OF ALLOTMENT DISCONTINUANCE, FINAL PAYMENT ROLL, SERVICE RECORDS AND ALLIED PAPER:
1 AGO 30-S
2 AGO 30-S |
ALLOTMENT DISCONTI NUANCE 4 |3 . *G° 3,°7.s .. i
WD AGO 30-S H ____AB0 30~s_
U 5 AGO 30-S |
U I 6 AGO 30-S I
I,
- Prepares allotment discontinuance notice for all cases, AR 35-5560.
STATEMENT OF CHARGES
WO AGO 36 fr”TAG_°_36_"■ P ““gTTg >■■■4]
( I F REOU I RED) | P2"“ ago~36 lOl ■ ■■!!■■ [2 T
l”3 1 H AGO 36 |__k
I «°36 j ।
— ——I
xx., - If requ ired, s igns and forwards ■
- If required, prepares statement of charges - files copy 2 in company property book
SOLDIERS DEPOSIT BOOK F J 1
WDFD 33 F0 33 FD 33 —— ^^1
(REPRINTED AS WD AGO 14-38) l«_aaM,wraJ I, . ___|
- Attaches any deposit book to fina-1 payment . )f s0,dler has deposlts, signs and forwards| "____________ ____________ i
FINAL PAYMENT ROLL 'nr W° 371 Jr WD 371 i
WD 371 r-—I wo 371
H13 wo 371 F U
U ~ | L WO 371
(, WO 371 I
- Prepares and forwards final payment roll ' deceives and signs
- Enters any deposits or charges ‘ Forwards wlth supporting documents
- Encloses copy 4 in service record
SERVICE RECORD pj----------
WD AGO 24 1 -
< ■ AGO 24 - Completes entries in service record - Copy 4, final payment roll, is enclosed in lieu of Extract of Service Record, WO AGO 25, which is not required.
SAGO 30-S
j 3 AGO 36 "jOB
I P 7771
T\ —
T _ AGO 24 —I
” NOTE 2
WO AGO form 30-s is completed for officers
- Assembles required records and forwards and enlisted men. Form 66-1, 66-2 or to TAG 66-3 is forwarded to The Adjutant General,
Officers Branch, Washington 25, 0. C., with the form 30-s. The officer's 201 file is mailed to the Demobilized Personnel Records Branch, AGO, High Point, H. c., noted deceased, as soon as practicable. —______________________________
1 Jan 45
TM 12-240
OF FINAL PAPERS
FISCAL DIRECTOR
FINANCE OFFICE OFFICE SPECIAL SETTLEMENT THE A0JUTANT OTHER OFFICES
ACCOUNTS NEW YORK GENERAL
Government Insurance Allotment Division New York, N.Y.
CAGO 30-S I [2
* 30-S I I 3 ..30-.s YJ B°nd
I ** AGO 30-S I W |U 30-S ^.Chicago,
r U S ago 30-S I sJ I 5 30-S
I® 6 U "6 “ | A^Office of De-
, AGO 30-S 30-s pendency Ben-
Nev.erk, N.J.
- Receives forms _ Receive
- Forwards with transmittal _ Discontinue allotments and
letters as outlined in allowances.
AR 35-5560.
NOTE I
Actions shown on this chart should be completed within three days after decease of military personnel .
F AGO 36 ~| F AGO 36__________|
> ■■^1 F1 PO 33 p~ CD 33 3
H I WD 371 I- M I1 HO 371 I
J I2 WO 371 I U [2 J
I, p Lk I, 'A'D 371
, WO 371 ▼ F
whmhbmhhibbI - Holds for receipt of Form 14, Claims For Arrears of Pay.
- Computes final payment roll , _ Does not hold over forty five - Forwards with supportingpapers days.
I
'AGO 30-S
F1 AGO 36 j
W 371 ' 1
\ AGO 2N
- Retains
37
TM 12—240 1 Jan 45
FINAL PAYMENT ROLL WD FORM 371
Voucher No.
FINAL PAYMENT ROLL -------------
of Walter Cory
Major, F.D.
Ft. Dix, N.J.
------------DotT. John J. 2 468 10g (Deceased)__________________181at Infantry_________________ Svm No 210500
(Organization)________________________________________________________(Regiment)_______________,
Sta. No. 12J5
------------J,,r"w----------------------------------------------------------------------------- ** i*1*
Discharged on See Remarks J 19______________________ Paid 19 (For use of Paying Office)
APPROPRIATIONS:
V/fO -----------Ft. Dix, N.J.____________24 July 1944
(Symbol) (Allotment) (Station) _ (Date)
____ 5^ QGQ . * certify that this roll is made out . as required by v z * ——— —————-- Army Regulations and that entries pertaining to each
name are correct; that where rental and/or subsistence --------------------- -----—---------------------- -------------- allowance is due, the soldier was not furnished rations in kina nor received the equivalent thereof in monev;
----------------------------- ----------------------------. ------------- that where quarters allowance is credited for the enlisted man, his dependents, or both, public quarters were not
____________________________________________________ __________________________________________ , available or assigned to such persons nor did they receive a monetary allowance in lieu thereof; and that payment Total amount disbursed ________________________________« / 6^0 tO Y1-?-xDj sJed men named on the within pay roll is not
______ 11 amount coursed----------------------- _ V ”------ prohibited by any provisions of law limittag the avail-
ALLOTMENT “ ------ --------------------------------------------------------------- ---------------i
Class “N^L_
Class “E”_ Date o. Name, Grade, and Component ALLOTMENTS
Enlistment No. (Date and place of acceptance for enlistment, or place of ______________________ _______________________
Class “D” (Induction Years receipt of notice for active duty, by reservist; indue- Serial No. Month ™ ~ —
Viass U— or call to Serv- tion; reporting for duty as National Guardsman under and year °Lass CIass Class Class dass Clas3
active duty) 1CB °.r Sraft t.he President, to which entitled to deducted N E D F B X
Glass _________]___ travel allowances.)___
Honorably discharged by reason of: Death
Class B _ -----------—-----------------------------------------------------------------------------------------------------------------
----(State reason and order, if any) jq-Q tjme lost under A. W. 107 except as indicated.
Class “X”__ I I . -. . .. .. . — ■ । ■ ' । JR
- -1--------------->_________OTHER COMPONENTS_________________________________________________________________________________
-------?-OTAI' A________________________PRIVATE____________________________________________
COLLECTIOI
10/42_______o Doe, John J. ____________________2 46S 109 Jun 1.14_________________________________22,00
’ Indctd. at Ft. Dix, N.J. May 10/42. lied Ft. Dix
----------- 4-N.J. Ji) 1 24/44, Due EM dpta. Feh 1/44_________________________$10;_____________________Jul____22.00_________________ Mar 1/44 $10. Due US GPLD $1.50. l)ot ent td T/P. 5. )
- - Illi ——I—I
Government
„ „ T 7 for use of finance department only
G. P. L. or *• ,___________________________>
TRUST FUN! CREDITS COLLECTIONS I .We h?.’2by acknowIedRe rcoeipt IN CASH of amounta in the I
q column Balance Paid" got opposite our respective names, and in
_ , r „ o> ----------------------------------[---- Sas0 °J payment of quarters allowances we certify that we (our
C. M. fines_ ... mnTAT O ] | CORONERS
FOLLOW UP REGISTER FOR'REPORTS OF INVESTI-
GATION (SERVICE COMMAND) • Flies duP|lc®te section of report of in-
vestigation for answering any requests for further investigation.
SECTION IQ FOLLOW UP OF A DELAYED REPORT OF INVESTIGATION OF DECEASED PERSONNEL
FOLLOW UP LETTER ON REPORTS OF INVESTIGA-
T I ON OF DECEASED PERSONNEL DELAYED OVER - If report has not been received by Service
FIFTEEN DAYS Command, eceives fol lev/ up letter or de- I
I eyed reports of investigation.
- Takes necessary action to complete report of investigation without delay.
- Replies by second indorsement to letter
MONTHLY LETTER PREPARED BY TAG FOR SIGNA- wlth,n ,1'/e days”
TURE OF DEPUTY CHIEF OF STAFF FOR SERVICE
COMMANDS (IF REQUIRED)
1 Jan 45
TM 12-240
OF INVESTIGATION
43
SERVICE COMMAND
BrMAliliri ....... THE ADJUTANT GENERAL ADMINISTRATOR OF VETERAN’S AFFAIRS
PERSONNEL BRANCH
OR MISCONDUCT STATUS.
FOLLOW UP REGISTER
- If the in11la I-notificat ion of deceased personnel to the Adjutant General indicates a report of investigation is required,enters case in follow up register.
- If misconduct status is undeterminedjcase ।------------------- will oe entered in register and investiga-
I • AGO 51 tion initiated. ___________________
II* AGO 51 I AGO 5! >■ )'“
I 3| AG0 51 ? ago 51
____________k H I ' |3 AGO_5I_________jA . Revlews.
U I CERTIFICATE U I DIAGNOSIS__________- Uses as basis of determination of LOD or
U p TESTIMONY JpM (J | I CERTIFICATE misconduct status for veteran's benefit.
1 F cormeTs \ 1' _LE_SLLM2"J_____1A
* findings U;! coroner,s
y FINDINGS -I ■
- Receives and transmits original report of in- _ Reviews, vestigation file. _ Determines line of duty or misconduct status.
- Does not rev.ew or approve. . Notes determination on each copy Form bl.
- Enters receipt of report on service command . forwards copy 2. Form 51 to the Admin.stra-follow up register shown below. tor of veterans Affairs.
- Retains original file.
FOLLOW UP I REGISTER
- Enters receipt of case in Service Command Follow up register.
__™ L____________________________________________ I1, letter i.
LETTER
- If report of investigation has not been re-ceived,enters case in follow up register and forwards letter by first indorsement to ” ’*r,^es initial follow up letter from trie
commanding off।cer. Casualty Branch on each report of investiga-
- If report of investigation has been received. }'°n wh«ch has not been received within files letter. fifteen days of the initial notification to
- Service Command assumes responsibility for Adjutant General.
all necessary .action to complete report of ’ Notes date on follow up register, investigation after receipt of letter.
lETTER F
- Receives reply.
- Takes necessary action to complete report. r-------------------u
- Replies to TAG not required. I LETTER |
| ■■■■■■ 2 MONTHLY p
MONTHLY I L LETTER
LETTER I
- Prepares one letter to each Service Conirander - Service Commander takes appropriate action each month listing cases over thirty days to complete reports of investigation. old.
- Letter will be prepared for signature of Deputy Chief of Staff for Service Commands.
TM 12-240
1 Jan 45
REPORT OF INVESTIGATION
WD AGO FORM 51
REPORT OF INVESTIGATION
(Under provisions oft (par. lc(4)(c), AR 345-415) (par. 21, AR 600-550))*
Station or command
Tilton General Hospital
Date 27 July 194-4
1. Person (deceased)
..9pej..JpJta_J,a__2468109,___Pvt,_,..181st_.Inf,_,..Fort Dix,..N.J...
(Name, Army aerial number, grade, and organization)
2. (Nature of injuries) (cause of death)* .JPeripheral.yaHaular..CQllapae^..sev.ere^..secandary-to.________________________________
(Medical diagnosis)
—.Brainy..laceration.of,...diffuse,..severe-.______________________________________________________________
3. How incurred .....Accidenta^^ at.2200, 25 July 1944, at.Fort Dix,. New Jersey.
(Complete details as to how, when, and where (injury) (death) • was incurred, including hour and date")
when..sQldier..lumped...in..fr.QiLt...Qf..a...tnjck...Q]jt...Qf...Q.Qn.tr.Ql...t.Q..pufih...twQ..members. .of..the Army Nurse Corps to safety who were walking beside the roadway. Soldier was then -UJiabl.e...t.Q..4JHap...t.Q..fiaf.e.ty..ixL..time...to..ayQld..being..run..dQwn-.____________________________
4. Investigation of the circumstances surrounding this (&&&XX (death)* has been made. All available witnesses were interrogated. The following pertinent facts were found to be correct:
Present for duty (yes) (gf) *
(a)
(0
(a)
(d)
(<9 (/) (P)
w (0
(1) Hour and date of commencement of absence _________________Duty._____
(2) Hour and date of termination of absence __________________Duty._________________
(Was) (XXXXXt4* within the territorial limits indicated by the authorization to be absent.
(KfiJO (was not)* under the influence of intoxicants. The use of intoxicants (was not)* the proximate cause. 7
fSEXX) (was not) * under the influence of drugs. The use of drugs (i£32) (was not) * the proximate cause. (Was) (®gQ®) * exercising reasonable care for his own safety.
OS®) Jwas MOfinolatinga^viL iwrahor military law. nor military orders or instructions, written or verbal. XaeXiXiAlAIGAi* 5 M -r)X XxWsXAritlv
(MX) (was not)* due to gross carelessness or negligence.
(Was) (£X££S$* mentally sound.
5. Remarks: .Soldier..sustained...the., i.njur.ie.s.which.resulted..in.h.is. death in a successful .heroic ..effort. .to Ba.ye._the lives ...of..two..members ..of ..the. Army Nurse Corps .who were .walking,in.the...roadway..and._wh.Q_.had not_.seen..the..approa.ch._pf..a..heavy Army vehicle .ax.Q.und..a...c.Qrnex..les£...than..t.wen.ty..y.ardn..away.<_________________/._________________________’..
FINDINGS
(In line of duty) (SgtJEJSKKHDfiBX) * (Not due to his own misconduct)
"James Dill Major, Ind
Investigating Officer.
Approved:
•strike out inapplicable words. Madison Pearson Commanding officer'.
[Additional sheets may be used for extension of rem.rk^g^^pl^ljejialp
October 13, 1942
10 31172-1 U. S. GOVERNMENT PRINTING OFFICE
Figure 20.
1 Jan 45
TM 12-240
622845 0 - 45 -4
CERTIFICATE OF THE COMMANDING OFFICER
Certificate of the Commanding Officer Co. A, 181st Inf., Ft. Dix,
Co. A, 181st Inf.
Ft. Dix, New Jersey
N.J.
25 July 1944
I certify that I am the immediate of John J. Doe, 2 468 109, Pvt., 181st that between the hours of 1/00, 25 July 1944 and 0600, 24 July 1944, he was present for duty at Ft. Dix, New Jersey.
commanding d£fleer
Inf. deceased, and
Roach n, Inf.
Figure 21.
45
TM 12-240
1 Jan 45
TESTIMONY OF WITNESS
TILTON GENERAL HOSPITAL FT. DIX, NEW JERSEY 24 July 1944
TESTIMONY OF MARY E. SMITH, N 759 001, 2nd LT, ANC
"My name is Mary E. Smith N 759 001 2nd Lt., Army Nurse Corps. At 2200 on 2J July 1944, I was returning from Post Theatre.No. 6 to Tilton General Hospital walking east on the south side of New York Avenue with my companion, 2nd Lt. Jean J. Jones, ANC. Quite suddenly I heard a shout and was violently pushed to the side of the roadway, along with my companion. A large truck which had approached us from the rear, passing east, ran over the spot where I had been walking. I heard a scream and saw a soldier lying on the road. The truck crashed into a tree. I went to the soldier's side to administer aid and Lt. Jones ran to the nearest telephone to call an ambulance from the hospital. There was little I could do for the injured soldier as his pulse had stopped and he was not bleeding externally. His head had been hit severely. The driver of the truck, Jack J. Marends, ran up to see,if he could be of any assistance. He said he had suddenly lost control when his left front wheel came off. I could see the wheel close by.
I waited until the hospital ambulance arrived and the attendant, Lt. John N. Morgan, ordered the soldier moved to the Tilton General Hospital. Later at the hospital I learned the soldier's name was Pvt. John J. Doe, and that he had died from a fracture of the skull.
He undoubtedly saved both of our lives."
I certify this to be a true statement.
Sworn t 24 Ju
Jhiiies IdIII
Inf.
gating Officer
Figure 22.
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1 Jan 45
24
TM 12-240
CHAPTER 10
GLOSSARY
24. The following glossary may be of use in carrying out administrative procedures for deceased personnel.
Emergency addressee . . .
Burial escort............
Burial expenses.........
Color guard.............
Commanding officer....
Commercial wire.........
Contract undertaker. . . .
Designated beneficiary. .
Effects of the deceased. .
The appropriate enlisted man or officer who accompanies and delivers the remains to the person designated to make the interment at the point of burial, and who, if requested, arranges for the color guard. He is preferably of the same organization, race, and sex as the deceased, and is of equal or higher grade.
As defined by AR 30-1830.
The guard who will accomplish military honors at the grave of the deceased.
Of the post, camp, station, airfield, hospital, or other military installation, Army corps headquarters, and in unusual cases of divisions.
Western Union.
An undertaker under contract with the Government to render whatever services are designated by the purchasing and contracting officei responsible for obtaining undertaking services. (See AR 30-1830.)
The beneficiary is designated on page 2 of the service record as amended, under “Remarks Administrative,” and is entitled to the 6 months’ gratuity and pay of the deceased serviceman, if his death is not due to misconduct. However, if the soldier has married after authorizing the above-mentioned entry, the widow of the deceased automatically becomes the beneficiary. Where more than one beneficiary appears, both are reported, giving respectives dates of designation (AR 600-600). A friend is not eligible to be designated as beneficiary.
Any and all belongings, other than Government issue property and those which might cause embarrassment to the deceased’s family. For example, send personal effects such as: one letter, one comb, one wrist watch; exclude personal effects such as: one French post card, hygiene items.
Government expense for shipment of effects.
Immediate commanding officer.
Investigation officer....
Legal representative . . . . Nearest Army post........
Nearest relative...........
Next of kin..........
Summary court officer . .
Surgeon............
TWX................
I
The person to be notified in case of emergency is shown on page 2 of the service record, as amended, under “Remarks Administrative,” or on the identification tag, or on the Emergency Addressee Card, WD AGO Form 43, if prepared.
Prepaid.
The officer commanding the organization to which the deceased is assigned, such as company, regiment, or battalion, as indicated.
An officer, preferably of field grade, designated by the commanding officer to investigate and report on circumstances of death and empowered with authority defined in AW 113.
As stated in AW 112.
Normally the military installation or division headquarters located nearest to the point of the accident or decease. This is further defined in AR 95-120, and AR 600-550 for deceased en route or separated from unit organization.
The nearest relative is shown on page 2 of the Service Record, as amended under “Remarks Administrative,” or on the Emergency Addressee Card, WD AGO Form 43, if prepared. See definition of next of kin following.
As defined in AW 112 “the widow; legal representative of the deceased, if such be found by said court; or to the son, daughter, father, provided the father has not abandoned the support of his family; mother, brother, sister, or next of kin in the order named; or the beneficiary named in the will of the deceased, if such found by said court.”
Defined-by AW 112 or AW 113, whichever is applicable.
The commanding officer of the Army hospital or senior medical member of the organization.
Communication deemed most applicable by the signal center, such as War Department net, commercial wire, or teletypewriter exchange.
U.S. GOVERNMENT PRINTING OFFICE 0—1945
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