C.C. Bricker Adjusted Compensation Form

C.C. Bricker Adjusted Compensation Form (1)

CAUTION: If a loan has been obtained from the Veterans Administration and not repaid the application must be forwarded to the office which made the loan. Failure to obey this instruction will cause delay in settlement. Do not write regarding application. All applications will be handled in order of receipt. If you do write for any purpose other than to notify of change of address, you will only delay action in your case. Filing application or calling in person will not expedite settlement.


APPLICATION (Application may be filed at any time prior to maturity of certificate) READ INSTRUCTIONS ON REVERSE OF APPLICATION --------------------------------------------------------------------------------------- (Location of station making settlement. Not to be filled in by applicant)

Penalty for making false or fraudulent statement in application "Whoever knowingly makes any false or fraudulent statement of a material fact in any application, certificate, or document made under the provisions of the Act, shall, upon conviction thereof, be fined not more than $1,000 or imprisoned for not more than 5 years, or both."

I hereby make application to the Administrator for the settlement of any amount due and payable

to me on adjusted-

service certificate No. 24919, dated January 11" 1925 amount $767.00 further identified by

No. A which was issued to CHARLIE C. BRICKER
(Type or print first, middle , and last name of veteran)

based upon military or naval service during the World War, who was born at Condit
(Place of birth of veteran)

Delaware Co. Ohio on Oct. 24 - 1886 and may who be further identified by Army,

Navy, or Marine Corps Serial No. 2480572, date of enlistment June 23rd 1918, date of

discharge May 1st 1919, and rank and organization at date of discharge Private unassg,d.

last assgd, to Co M. 362 Inf

I hereby surrender all right, title, and interest in the above-described adjusted-service certificate.


Fingerprints of Right Hand of Veteran
(Imprint of four fingers taken at same time in presence of
person identifying)

Please print or type- }
write address of
veteran here. (This
is address to which
settlement will be
sent.) }


CHARLIE C. BRICKER
(Signature of veteran)

R.D. # 2
(Street address or route number)

GALENA OHIO.
(City or town and State)


CERTIFICATE OF IDENTIFICATION

(NOTE. --Certificate should be executed by some authorized person as set
forth in item 6 on reverse side of application.)

STATE OF .....................}
COUNTY OF................ } ss:

Date.............................., 19......

I, .................................................., do hereby certify that I am .................................
(Name of person certifying) (Title of office or position)

and that the person applying for settlement, evidenced by the above application, is known to be the veteran named and

referred to therein and that the signature and fingerprints thereon are his and were made in my presence.


................................................................................................................................................

(If the person certifying is a notary the above certificate must bear the notarial seal; if a postmaster, an impression of the cancellation stamp of
the postal station should be made on the above certificate.)

VETERANS ADMINISTRATION
Adjusted Compression Form 1701
January 1936

Charlie C. Bricker's Adjusted Compensation Form (2)

INFORMATION CONCERNING SETTLEMENT OF ADJUSTED-SERVICE CERTIFICATE

1. If no loan is outstanding against the adjusted-service certificate it should be forwarded with the application to the Regional
Office or Veterans Administration Facility conducting Regional Office activities nearest the applicant's home. Facilities at
which Regional Office activities are not conducted are not authorized to make these settlements.

2. If a loan was obtained from a bank but has not been redeemed by the Veterans Administration the application will be
executed and forwarded to the Veterans Administration, Arlington Building , Washington, D. C.

3. If a veteran obtained a loan from the Veterans Administration he was furnished a pink slip (Form 1184-c). The same
would be true if a loan was obtained from a bank and redeemed by the Veteran Administration except that the form would be
numbered 1186-a. In such a case if either form is in the possession of the veteran it should be attached securely to the applica-
tion when submitted.

4. The name and address to which you desire the proceeds of your certificate mailed should be printed or typed in the space
provided therefor on the face of this application to avoid any mistake in name or address. The Post Office Department will
not accept mail unless addressed to an individual at an established post-office address. Therefore, in giving the post office to
which settlement is to be mailed, care should be exercised to give the name of place or post office correctly.

5. It is important that the information required in the application be furnished in order to insure positive identification.

6. IDENTIFICATION. ---Before settlement is made on an adjusted-service certificate the person applying therefor will be
identified as the person entitled to the settlement for which an application is made. If in the United States or possessions
certification will be accepted if made by a United States postmaster or assistant postmaster over an impression of the post-office
cancellation stamp; a commissioned officer of the regular establishment of the Army, Navy, or Marine Corps; a member of the
United States Senate or the House of Representatives, an officer, over his official title, of a post, chapter, or other comparable
unit of organization under Veterans Regulation No. 10, or an officer over his official title, of the State or national
body of such organization, or any person who is legally authorized to administer oaths in a State, Territory, possession, District
of Columbia, or in a Federal judicial district, of the United States. If the identification is made in a foreign country, it will be
to administer oaths under the laws of the place where identification is made; provided there be attached to the certificate of
such latter officer a proper certification by an accredited official of the State Department of the United States that such officer
was authorized to administer oaths in the place where certification was made.

7. In the rectangle set-off on the left side of the application blank, the applicant will make his ( her ) fingerprints. The
fingerprint impression of the four fingers of the right hand are to be made all at the same time after the fingers have been inked
with black printer's ink, or by using a stamp pad. If possible use printer's ink. It is necessary that the ridges in the print
be clear and distinct; otherwise the application will have to returned to you for better fingerprint impressions. In case any
or all of the fingers of right hand are gone, take impression of the fingers of the left hand, stating under the fingerprints
that is the left hand instead on the right. In the case of veterans who are mentally incapacitated and application is being
executed by a representative of the veteran, the veteran's fingerprints will be obtained if possible. If this cannot be done, as
also in the case of an individual whose fingers are all missing, make a statement to that effect in the space provided for the
fingerprints.

8. After making out your application, go back over it and check each item so as to be sure you have omitted nothing, and
that each item is properly filled out. It will be especially noted that the application must be signed and fingerprints made in
the presence of the certifying person certifying as the identity of the veteran.

Charlie C. Bricker's fingerprints made with stamp pad.