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Report, A. R. Mauney:  Interview with Robert William Tidwell


North Carolina Department of Insurance                                                                      Form-ID-5


File: Kimble, Ted
Activity: Interview
Date Activity: July 28, 1998

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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