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North Carolina
Department of Insurance
Form-ID-5
File: Kimble, Ted
Submitted by: A. R. Mauney
On July 28, 1998, Investigator A. R.
Mauney interviewed Robert William Tidwell, W/M, DOB: December 30,
1973 (age-24), who resides at 4809 Brompton Drive, Greensboro, NC
27407,
telephone (H) 336-292-1438, (W) 336-297-5054, at his place of
employment, Vocational Services, 407 Norwalk Street, Greensboro, NC
in regard to a change of beneficiary insurance form for a policy of
insurance issued to Patricia Blakley Kimble, and Tidwell stated
substantially as follows:
That he was employed by Ted Kimble at
Lyles Building Supplies
as a general laborer. One day he was working at Ted and Patricia
Kimble's house in Pleasant Garden, NC and Ted gave him a couple of
papers to sign and showed him where to sign, which he did.
On this date, July 28, 1998, Robert
William Tidwell reviewed two Southland Life Insurance Company
documents, one, a change of name request, and secondly, a change of
beneficiary request, both dated September 8, 1994, for a policy of
insurance issued to Patricia G. Blakley, policy number,
51-89-1798019. Tidwell stated that it was his signature on these
forms as a witness for the signature of Patricia Kimble. Tidwell
further stated that he did not see Patricia sign these forms and
does not recall whether her name was on it or not when he signed as
a witness.
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