[5]| (NW 88326
[6]Dochd:372433279 Page 1
[8]2
[10]. ad
[11]n
[13]Assassination Records Review Board
[14]Final Determination Notification
[16]AGENCY : HSCA
[17]RECORD NUMBER : 180-10068-10363
[18]RECORD SERIES :. STAFF PAYROLL RECORDS
[19]AGENCY FILE NUMBER : . |
[21]December 8, 1995
[23]Status of Document: Postponed in Part
[25]Number of releases of previously postponed information: 11 |
[27]Reason for Board Action: The Review Board's decision was premised on several factors
[28]including: (a) the significant historical interest in the document in question; (b) the —
[29]absence of evidence that the release of the information would cause harm to the United
[30]States or to any individual. |
[32]Number of Postponements: 9
[34]Postponements: All the postponements in this document represent Social Security numbers.
[35]Reason for Board Action: The text is redacted because the public disclosure of the redaction could
[36]reasonably be expected to constitute an unwarranted invasion of personal privacy, and that invasion of
[38]privacy would be so substantial that it outweighs the public interest.
[40]Substitute Language: SSN
[42]~ Date of Next Review: 2017
[44]- Board Review Completed: 10/24/95.
[47]Date:08/20/93
[48]- Page:1
[49]JFK ASSASSINATION SYSTEM .
[51]. IDENTIFICATION FORM
[53]| AGENCY INFORMATION
[54]AGENCY : HSCA |
[55]RECORD NUMBER : 180-10068-10363
[57]RECORDS SERIES
[58]STAFF PAYROLL RECORDS
[62]AGENCY FILE NUMBER :
[64]_ DOCUMENT INFORMATION
[66]ORIGINATOR HSCA
[67]FROM
[68]TO
[70]TITLE
[72]01/01/77
[73]11
[75]DATE
[76]PAGES
[78]. SUBJECTS
[79]HSCA, ADMINSTRATION
[80]GRIMES, MARY SUSAN
[82]DOCUMENT TYPE : PRINTED FORM
[84]CLASSIFICATION : U
[86]RESTRICTIONS ;: 3
[87]CURRENT STATUS : P a
[88]DATE OF LAST REVIEW : 07/07/93
[90]OPENING CRITERIA
[92]COMMENTS
[94]Box #:1.
[96]{R] ~- ITEM IS RESTRICTED
[98]‘NW 98326
[99]Docld:372743329 Page #
[101]PAYROLL AUTHORIZATION FORM
[103]A Us. HOUSE OF -REPRESENTATIVES(_)° (Any erasures, corrections, or changes:
[104]oe Washington, D.C..20515
[106](Please Use Typewriter:
[107]or Ballpoint Pen)
[109]authorizing official.)
[111]To the Clerk of the House of Representatives:
[113]| hereby authorize the following payroll action:
[115]Employee Name (First-Middle-Last). =. 3 = Effective Date
[117]12/31/78 a
[119]Mary gusan Grimes ..-
[121]212-56-6718 1 Appointment :
[122]) Salary Adjustment
[123]C) Title Change
[125]SGI Termination (At close of business on effective date}
[127]Employing Office or Committee/Subcommitiee
[129]Age aesdinations C1 Leave without pay (Beginning with effective date above and ending
[131]close of business... = = = )
[132]: Specify Date
[134](If type of action is an Appointment, Salary Adjustment, or Title Change, complete appropriate information below.)
[136]Position Title Gross Annual Salary*
[138]._ * If employee is a civil service annuitant (includes U.S. House of Representatives}, the gross annual salary shown should include the ‘annuity received by the employee
[140]plus the salary received from the employing office.
[142](If Committee Employee, complete appropriate item below.)
[144]1. 0 Standing Committee: Staff—Li Ciericai or 0 Professional.
[146]2. Special (Investigative staff of Standing Committee) or Select Committee: Authority—H. Re@5& __of Sth Congress.
[148]3. C1 Joint Committee.
[150](If Employee of an Officer of the House, complete item below.)
[152]Position Number ~__If applicable, Level_
[154]| certify that this authorization is not..in violation of 5 U.S.C. 3110(b), prohibiting the employment of
[155]relatives.
[157]Date. Janueags 2 WI
[158]. (Signature of Authorizing Official)
[159]LOUIS STGXES
[160]“(iFappropriate, signature of Subcommittee Chairman or Ranking Minority Member). Type or printnome-of Authorizing Oficial), ~=—=SOSt*=~“S*~=<S*CS
[161]CRALTRMAN
[163]All appointments and salary adjustments for employees under: the House Classification Act and for Committee em----
[164]'. ployees, except those of the Committee on Appropriations, the Committee on the Budget, and the Joint Committees, must.
[165]_.be approved by the Committee on House Administration. :
[167]Chairman, Committee on House Administration
[169]APPROVED:
[171]Office. of Finance use only:
[172]Office Code
[174]Monthly Annuity $
[176]ae Se aad pe “Copy for: Initiating Office-or Gommittee.% oe.f ee we
[178]NW 88326 ee —
[179]ocld:32243329 Page 3 : ; et! !
[181]on this form must be initialed by the
[183]; Employee Social Security Number | Type of Action =
[185]a
[186]WMkubl ue AG Se es
[188]So ea ta wee
[189]AES i ee a tthe
[191]FO Erste EROS CeCe UW Res Pr OES Bk TOR RCE LEED Y POMEL SF RO SEDO CDESC ONCE IOT TSE. Tin PS TT OE CTT
[194]So ptt
[198]ws Mee Lari Adee tess Wien tat a ate et at te Nae tailed
[202]a
[204]- (If Committee Employee, complete appropriate item below.) “ S
[205]1. oO Standing Committee: Staff—O Clerical or 0 Professional:
[206]2. 1) Special-{Investigative staff of Standing: Committee). or Select Committee: ‘Authority—H. Resse | _o PSE Congress. ;
[207]3. 0 Joint Committee. .
[209]_ (If Employee of an Officer of the House, complete item below.)
[210]Position Number_____________.___If applicable, Level. Step__
[212]PAYROLL AUTHORIZATION Fe-"4= -
[213]S
[215]U:S. HOUSE OF - REPRESENTATIVE
[216]“. - @ Washington, D.C. 20515
[218](Any erasures, corrections, or changes.
[219]- 9n this form must be initialed by the |
[220]~ authorizing official.).
[222](Please Use Typewriter:
[223]or Ballpoint Pen)’ ~
[225]To the Clerk of the House of Representatives:
[227]| hereby authorize the following, payroll action: mo
[229]_-Employee Name (First- -iMliddle-Last) ; 7 —_ To __ Effective D: Date
[230]Mary Susan Grimes Novenber i, 2878
[232]Employee Social Security Number © mi : — | “Type of Action
[234]=C] Appointment
[235]0 Salary Adjustment
[236]“1G Title Change
[237]( Termination (At close of business on effective date)
[239]1) Leave without pay (Beginning with effective date above and. ending |: ° a
[240]close of business
[242]Specify Date
[244](If type of action is. an Appointment, Salary Adjustment, or Title'Change,-complete appropriate information below.) -
[246]—_ Position Title Gross Annual Salary* _ a
[248]Reeearcher . 34,268.90 | ‘
[250]..* If employee jis a civil service annuitant (includes U:S. House of Representatives), the gross annual salary shown’ should include the annuity received by the employee
[251]plus the salary received from the employing office.
[253]| certify” that this authorization. is not in violation oof 5. U.S.C. 3110(b), Prohibiting theemployment: of
[254]relatives. - — Fe ;
[256]Boverber 8 a eo
[257]Date. ee. inh ie
[258]: : . a : (Signature of Authorizing Official) 5
[259]we LOUIS STORES
[260]Af cpproprai, “Signature of Subcommittée Chairman or Ranking Minority Member) “7 oT Type or print nome of Authorizing Official), SSC 4
[261]Chairman
[263]Ao
[265]All appointments .and. salary adjustments for employees under the House: Classification Act and for Committee em-
[267]ployees, except those of the Committee on Appropriations, the Committee on the Budget, and the Joint Committees, must”
[268]be approved. byt the Committee on House Administration.
[270]APPROVED:
[272]Chairman, Committee on House Administration .
[274]Office of Finance use only:
[275]Office ete
[278]Certificate of Relationship/Nonrelationship to
[279]Any Current Member of Congress
[281]78
[283]I certify that I do not have any of the following relationships to any
[284]current Member of Congress.
[286]father nephew sister-in-law
[287]mother niece stepfather
[289]- son husband stepmother
[290]daughter wife stepson
[291]brother father-in-law stepdaughter
[292]sister mother-in-law '  stepbrother —
[293]uncle '  gon-in-law stepsister
[294]aunt daughter-in-law half-brother
[295]first cousin brother-in-law. half-sister
[297]fli certify that Iam the _.._SES Cf the
[299](Relationship)
[301]Honorable
[302]: (Name of Member to whom related)
[304](Employee)
[306]GPO 16~-78695-3
[308]2 te ad
[311]i pce us’. ce “pISTRICT - UNEMPLOYMENT - COMPENSATION BOARD
[313]Rete qfF8
[315]: Fraployee - —_ 6 abe
[316]; Bogle Se rity No. __212-56-6718. a ae Name
[318]| oe During the CALENDAR WEEK beginning SUND O¢ A ae
[320]Ie ‘tion for that week were 563.64... 7
[322]2, Hig gross earnings payable before deductions, which include tips, ‘eash value of meals, lodgings, and all other remunera- s
[324]. sxroooutroooeooxapopoaaaioaAKKEARRAEEHOOPOREERAOADAREEN CO
[326]NW 88326
[327]_ Docld:32243329 Page. &.
[329]a " Pealson’ for separation -— employee. _ works: ¢ ‘one._day.-a. heck until ond-of-Devenber=-——
[331]fo)
[332]o
[333]a,
[334]62"
[335]By
[338]3
[339]Ke)
[340]1
[341]a:
[342]oo
[343]a
[344]a
[345]1
[347]i
[349]'
[351]i
[353]a |
[355]t
[357]|
[359]'
[361]t
[363]|
[364]|
[366]i
[367]"|
[368]|
[370]|
[373]‘4, Simploy e's Name. Se ee as ee _—- che eee a
[375]- LOW EARNINGS REPORT—To be completed by the employer and delivered oe we Le
[376]to the claimant at his request. satis 7
[380]AY October 22
[382]aero ein ee on a a ae na aan
[384]_ this employee worked (1. FULL. TIME PART TIME o.°
[386]2.. His. gross earnings payable before deductions, which include tps, « cash value of meals, ste .
[388]SATURDAY __October 28 _ ic (NOT your payroll ‘week, i different), Say
[390]io
[392]3. Original employment date 11.
[394]Select Committee. .on Assassinations
[395]:, Employer's Name ——-~—-~----
[397]and U.S touse- Of Bep resentatives .
[399]fdaress nanan Bann a an a ee nnn
[401]Inne Pot ae LL (Lie Tom Howarth. 2252980...
[403]Bien ena "Person * who may , be » eoatactad) |
[405]re emer e mrnee a eo ane fae A te A ee ae ne ht RL
[407]oer wines ee wenn mn einen a er teen uaa ae a me A eee olin ese
[409]‘(Signature ure of oii voniensl) a 3-55704
[411]om LER accepted 2 as san hadietonat {
[413]“Date of Claim Be
[415]fo: ace a oe! ‘DISTRICT U NEMPLOYMENT COMPENSATION BOARD -
[416]pee WTB - LOW EARNINGS REPORT—To be completed by the employer and | delivered
[417]i _ _ _ -\ to the ciaimant at his request. ~ . a :
[418]SEE ey No. 21275676718 Name _Mary.. Susan Grimes. ae af
[419]_.October 15.) © _ ; gee
[420];. During the CALENDAR WEEK beginning SUNDAY wane and ending -
[421]” SATURDAY ___ October 21 Ws (NOT your payroll week, | if ' different), ” mo - ons
[423]this employee worked (1. FULL TIME cX PART TIME
[425]7 tion for that week were 5.63.64. 2. a oe ; . oe mo
[427]Oct 18 Pe Last day fone 2EE BB wt
[429]Select Committee ¢ on Assassinations
[431]U.S. ae of Representatives ee
[432]ur L CoCr LEM PTE.. “tom Howarth 2250 ~2980 |
[433]avey — a ae _ : (Person who. may be contacted). i - ; (Phone "No. > - J
[437]OFF ICE USE ONLY
[439]1c] LER accepted 2 as an | Additional Chain (Carnings exceed eligibility amount. ), . a
[441]ed Po en nn ened ee
[443]‘Date of Claim _ ae Office ‘Representative
[445]PAYROLL AUTHORIZATION FORM Po CE 4
[447](Please Use Typewriter - ve ~UWws.: ‘HOUSE OF. REPRESENTATIVES (Any erasures, corrections, of changes.
[449]aenet a, os : co. + On. this form must be- initialed by the
[450]or Ballpoint Pen) Washington, D.C-20515° authorizing official.) :
[454]To the Clerk of the House of Representatives:
[456]| hereby authorize the following payroll action: :
[458]Employee Name (First-Middie-Last).  - --—=«| =~ Effective Date
[460]Mecy Susan Grimes . a |. 9f45778
[461]Employee Social Security Number = Je _Type of Action
[463]21 2—56—_47 18 | O Appointment
[465]; _- O Salary Adjustment, . © %
[466]- Employing Office or Committee/Subcommittee ©. ~~ |.C Title Change
[467]. _ Gk Termination (Ai close of business on effective date) 8
[468]Assassinations 1 Leave without pay (Beginning with effective date above and ending |. :
[469]; close of business ;
[471]Specify Date ;
[473]_ (If type. of action-is-an Appointment, Salary Adjustment, or Title Change, complete appropriate information below.) :°
[475]Position Title fos : Gross Annual Salary*
[477]. *AE emoloyee is a civil service annuitant {includes UsS¢ House. of Representatives the > gross ‘annual: ‘salary shown. should include the* annuity received! by the employee *
[478]plus the salary received from the employing office.
[480](If Committee Employee, complete appropriate item below.) - ; 4 eo
[481]- \
[483]1. O Standing Committee: Staff—O Clerical or 0 Professional. : = \
[485]2. Ed Special (Investigative staff of Standing Committee) or Select Committee: Authority—H. Res._236_of- 22% ICongress 2 \
[487]3. 0 Joint.Committee. 4
[488](If Employee of an Officer of the House; complete item. below.) 4 a
[490]3
[492]Position Number___._- wate eee. lf applicable, Level. Step___ .
[494]. | certify. that ‘this. authorization | is -not~in violation. of -5-U. s. C.. 3110(b), prohibiting the employment of a
[495]relatives. e
[496]Dote.___ September 24 000 1978 a
[498]Gignoture “of Authorizing Official) 2A
[499]LOUIS STOKES, GHATBEAR &
[501]N
[503]» °° - All appointments: and salary ‘adjustments for employees under the House Classification Act and-for Committee em- |
[504]. ployees, except those: of the Committee on Appropriations; the Committee: on-the> Budget, and -the’Joint Committéés, must -
[505]be approved by the Committee on House Administration. - : .
[509]APPROVED:
[511]. . my vat ae
[512]. : _ tle oie
[513]PE OTO CEL SNORE OPCATEIE: LID ct act Leas
[515]Office of Finance use only:
[517]Office Code
[519]sot lang eect
[522]are -.4t . . a i rt er ett er tt mentee ie sentient”
[524]: wee jones ee rb ne ee eee
[527]~ “U s. ‘HOUSE: OF REPRESENTATIVES:
[528]"Washington, D.C. 20515 *. +
[530]“e(Any erasures:- ‘corrections: :or :changes.:..*.
[531]..-- On -this form must be:: initialed . -by the; .
[532]~ authorizing official.)
[534]t
[536]: «Please Use’ Typewriters:
[537]‘a a or Ballpoint Peni): ®
[538]|
[541]To the Clerk of the House of Representatives: © °° <0 ns
[543]| hereby authorize the following-payroll action:
[545]oe ‘Employee: Name (First-Middle-Last) a ee a “Effective Dates
[546]Hary Susan Grimes
[547]~ Employee $ Social Security Number: = = a [ee z Zz ; a | - Type of Action a
[548]212 56 6718 1 Appointment,
[549]Employing Office or Committee. oe} a | Selary Adjustment
[551]‘. Assassinations : oh J] Termination (At close of bisiness on: effective date).
[553]~ (IFtype: of action:is an-Appointment or Salary Adjustment;-complete the following-information,) © 2c
[555]i Position Title Bross Annual Salary
[559]- (If Committee Employee, -complete appropriate item -below.):..
[560]ok [J Standing Committee: Staff—[7] Clerical or [-}'Professional. 2°
[561]7 a ~ 2.§8) Special or Select Committee: Authority—H: Res... $82 of SSER Congress. ~
[563]3 OO. Joint Committee. :
[565]L (If Employee of an Officer of the House; completevitern:below.) vets 02% Oa s a
[566]Position Number 21 2.2-.lF applicable, Levels Steps.
[568]Loe A cont that: this. authorization. is “not-sin~ violation. of 5. :U.S.C>: 3110(b), -prohibiting: the: ‘employment: offer
[570]relatives. vemevseweel oe
[572]TT i a ee er PL
[574]Type or print name of Authorizing Official)
[576]a
[579]yf - (Title-If Member, District and State)
[581]rr rs i a sn ee i ee Stestenientenstnatadantentenianietententenientantetaetantalmieiestesterleieteertederioaiecion Pras
[583]All -appointments-and-salary ‘adjustments for employee's. under-the. House’-Classification ‘Act -and for: Committee ‘em-'
[585]: C
[586]; -_pleyees, except::those-ofzthe.Committée on: Appropriations,’ the Commiftee:.on the: Budget, ‘and the JoiAt ‘Committees; must \
[587]~ be: approved. by. the: ‘Committee on House Administration. °2. ‘se. 5 - toe c moe \
[591]- APPROVED:
[593]Office of Finance use only: .
[594]Office Code.
[596]Copy -for initiating Office or Committee 92 jc ei ee
[599]a ployees,. excepti:those of the Committee on Appropriations: t ‘the Committee ‘on: the Budget, ‘and. tthe: Joint’ “Committees, must:
[600]po
[602]PAYROLL AUTHORIZATION FORM
[604](Please Use Typewriter a U S. HOUSE OF: REPRESENTATIVES . =" (Any erasures, corrections, or changes :-.
[605]_or Ballpoint Pen) ==. Washington, D.C. 20515 2 Se nad be initiated by the
[607]To the Clerk of the House of Representatives:
[609]| hereby authorize the following payroll action:
[611]Employee Name (First-Middle-Last). oe 8 vs, _ a ‘Effective Date oe
[612]_Hary Susan Grimes | ATT
[613]“Employee Social Security Number
[615]212 56 6718
[617]ie ion
[619]L] Appointment
[620]“Employing Office or Committee =. 7 8 Sclary Adjustment
[622]Assassinations . . | Termination (At close-of business on effective date) .
[624]- (If type of action is an Appointment or Salary Adjustment, complete the following information )
[626]Position Title
[629]2 Sans Shac lake soe alse igre ta ado STATE an Pies eh Ba ER, FATS sete cath eg!
[631]“Gross Annual Salary - _
[633]57%,
[635]TaN R EOE en EDT NTI Tn We ONY
[639]N
[641](If Committee Employee,.complete appropriate item below.)
[643]-1. LJ Standing Committee: Staff-[_] Clerical or [5] Professional.
[645]2. [3 Special or Select Committee: Authority—H. Res..409 __ _of- 95th
[647]ISTH Congress:
[648]3.C] Joint Committee.
[649](If Employee of an Officer of the House, complete item below.) |
[650]Pésition, Number. If applicable, Level_- Step__-
[652]- Lecertify: that: this authorization is not in violation of 5” USC » 311 0(b), prohibiting the employment of as
[653]relatives. ; aye
[657]a of Authorizing Official) :
[659]a “Louis Stokes
[661](Type or print name of Authorizing Official) -
[665]all appointments and salary adjustments for employees under. the House . Classification Actand for Committee em-
[667]‘be. approved by the Committee on House Administration. :
[669]APPROVED:
[671]Chairman, Committee’ on: + House Administration Be
[673]Office of Finance use only: os : 4
[674]Office Code a
[675]. Copy for. imitiating Office or Committee Se 4
[676]| NW 88326 PO a
[677]| Docld:32243329 Page 9 : Pegs
[680]PAYROLL AUTHORIZATION: FORM. er re
[682]wee (Please: Use:Typewriter « -o-* U. S:: HOUSE: OF.. REPRESENTATIVES: - ooo. co(Any erasures,. corrections,-or- changes. +.
[683]: ws Washington, D. C.20515 . . On this form. must, be, initialed by. the.
[685]or Ballpoint Pen) authorizing official.) ©
[687]To the Clerk of the.House of Representatives:
[689]| hereby authorize the following payroll action:
[691]“Employee Name (Fitst- “Middle- -Last) ote ee Effective Date.
[693]Har ry ) Susan Grimes
[695]Employee. Social Security Number: Type of Action
[697]“22-56-6718
[699](] Appointment
[701]Employing Office or Committee - - ae) (Salary Adjustment .
[703]. Select Comal ttee on Assassinations {] Termination (At close of business ¢ on effective date} -
[705](If type of action is an Appointment or Salary Adjustment, complete the following information.) .:
[707]Position Title . om Gross Annual Salary — . 7
[711](If Committee Employee, complete. appropriate item below:}:25"" soe oy
[713]1. [-] Standing Committee: Staff—[_] Clerical or {J Professional...» -
[715]2: [8] Special or Select Committee: Authority—H: Res. mas of __95 Congress.» 2"
[717]3. [_] Joint Committee:
[719](If Employee of an Officer of the House, complete item below.) «0-5 8 co teaters
[721]Position Number ane _. if applicable, Level _-
[725]-¢becertify,that. this. authorization. is: not: in: violation -of. 5 -U.S.C. -3110(b); -prohibiting- the..émployment..of:.<-
[727]relatives.
[729](Signature of Authorizing Official)
[731]Henry B. Gonzalez
[733](Type or print name of Authorizing Official): - -
[734]| Chairman
[736]ae yy. All appointments:and-salary: adjustments-for employees under the.House-Classification-Act*and: for ‘Committee :em-7:
[737]ployees; except ,thoseof the :‘Committee.on-Appropriations;the- Committee: ‘on--the; Budget; and: the.Joint: Committees,«n musts:
[738]-be approved by the Committee: on-House:Administration. © ot che te fe ee ee ak ae 2a
[740]_ ARPROVED:
[742]Chairman, Committee on House Administration -,
[744]Office-of Finance use onlyz. 00 oe
[745]_ Office Code
[747]Copy for. Initiating. Office or Committee:
[749]tek Uh i yan teae Slo Meet gt
[751]ee se a en ee ee
[752]| 88326 | DO _.
[754]1d:32243329 Page 10 ; “eens ;
[758]5 =
[759]3 +
[760]one
[763]° a a _ i !
[764]~- (If type of action is an Appointment or Salary Adjustment, complete the following information.). oe a |
[766]| PAYROLL AUTHORIZATION FORM. . . oe :
[767]I ~ (Please Use Typewriter” te Ne U. Se HOUSE OF REPRESENTATIVES ~~ (Any erasures, corrections, or changes -
[768]i this form must be initialed by the
[769], | or Ballpoint Pen) | ~ Washington, D.C. 20515. | “authorizing official.) - |
[771]| ~ To the Clerk of the House of Representatives: == ee
[772]- y . ° . . . ‘
[773]| hereby authorize the following payroll-action: — oo - \
[774]Employee Name (First-Middle-Last), «|= ~=Ss*s*é=«~S*é«@éfective Date fe
[775]= ; —_ - To | i
[776]Mary Susan Grimes. — 4 WaT? Co <
[778]CL) Appointment . ~
[780]Employing office‘ Committee ~ =i: Solary Adjustment © SS
[782]“Select Commi thee an A issassina tions mo L] Termination (At close of business « on effective date)
[784]Position Title a ae y _
[788][
[789]. (If Committee Employee, complete appropriate item below.) a re |
[790]+ . . . . . i
[792]1. E) Standing Committee: Staff] Clerical or [_] Professional:
[794]-_ 7 7 se aseh SO wy
[795]« 2. [7] Special or Select‘Committee: Authority —H- Res... of! "*""_ Congress. . re ,
[797]‘~3. [-] Joint Committee. Be . Oe sO -
[799](If Employee of an Officer of the House, complete item below,). / _ |
[801]Position Number : if epplicable, Level _
[803]a
[805]| -certify.. that this authorization is not- in. violation of 5 US.C, -3110(b), prohibiting + the employment of -
[806]relatives. o ~ an . . ~
[808]|
[810]~= Sep a :
[811]. |
[813]|
[815]|
[817]. TSignoture of Authorizing Official)
[818]~. : , 48 » By oo
[819]- No ‘ - Hanpy 3. Serzvaler
[821](Type or ‘print name of Authorizing Official)
[823]— Chat rien , , ‘ °
[825]oloyees; except those of: the-Gommittee. on Appropriations, the: Committee- ‘on the. Budget, ‘and the Joint Committees, must -
[826]-‘be-approved by. the ‘Committee on House Administration: :
[827]re
[829]a  APPROVED:._
[831]Office of Finance use only:
[833]Office Code.
[835]|
[836]|
[837]all appointments and salary adjustments for employees under the: House: Classification Act and for: Committee.em- 7
[838]I
[839]|
[840]|
[842]88326 : Doe
[844]| a poe ee ee ee
[846]id:32243329 Page 11 : Pye!
[848]pos ; C. = _ J ~ = |
[849]: PAYRGLL AUTHORIZATION ue . , lam ° “ |
[850]I. ‘(Please Use Typewriter ~ Ne U.S: ‘HOUSE OF. REPRESENTATIVES { SY cy erasures, corrections, or changes: |
[851]| or. Ballpoint Pen). Washington, D.C: 20515. “on this form must be initialed: by the:
[852]P oF Dal point. ; > oo authorizing official.)
[854]IE aa To the Clerk ‘of: the House ‘of: Representatives: : 7 > a |
[855]| ( |
[856]| hereby authorize the following payroll action: ~~ i
[857]i Employee Name (First-Middle-Last) “Effective Date |. |
[858]Vase], . .
[859]rn oe Employee Social Security Number - oe Type of Action |
[860]; { te ' : ' - 7 7 . -
[861]| . 212 548 8778 - : .| 2) Appointment ~ _ |
[862]7 Employing Office or Committee O Salary Adjustment ae - a ae
[863]| Sal ar % Lomeittee on ASSA83i inations Oo Termination (At close of business on effective date)
[864]yo . , . .
[865]| pS om ’ 8 CO
[866]: (If type of action is an Appointment. or Salary Adjustment, complete the following information.) ~ — |
[867]| | | - Ss 5 |
[868]: |
[869]bee ie . sy
[870]| oo
[871][- y sO 2 . ; f ;
[872]~~ (If Committee Employee, complete appropriate item: below.)*"~' ‘ _ °
[873]- 1.) Standing Committee: Staff—[_] Clerical or [_] Professional. 7 x.
[874]= Soor 2.) Special or Select Committee: Authority—H. Res. 12 o _of FEN Congress.”
[875]| | rc a ; - |
[876]. 3. _] Joint Committee. |
[877](if Employee of an Officér.of-the House, complete item below.) » - .
[878]= Position Number. 2 If applicable, Level__ oo . Step an o y oo |
[879]a a P ; |
[880]| -certify.. that this quthérizotion is not “in violation, of 5. USS.C. 3110(b), prohibiting: the. employment: of 7
[881]relatives, |
[882]Date oo ? a December 30. a 19 #6 ‘ , _ ne ; _ : me wt . ~N ; 5 ;: J
[883]a : ee TN ( Sigraire of Authorizing Oia |
[884]- - Thomas U. Downiag, Chairman |
[885]OO Se —Aomes Ae ome print name of Authorizing Official) ==SSStS=~CS 7
[886]no — = Select Committee on Assassinations |
[887]ne - re Tle Hf Member, Disrictond Sate) oT ~
[888]|
[889]- i
[890]j
[892]i’
[894]All ‘appointments and:salary adjustments: for employee's under the House Classification: Act. and: for Committee=em: ~
[895]- sployees;: except. those: ‘of-the-Committee on; Appropriations, the: ‘Committee on -the Budget, -and::the Joint Committees; ‘must “©
[896]‘tbe approved” by. the Committee: on House Administration. - : .
[898]root co. re . _ APPROVED: a
[899]- y, - - -|
[900]Office of Finance use only: ae
[901]Office Code we |
[902]Monthly Annuity $__________00 . -
[903]* Copy. for Initiating Office or Committee. --- 4
[905]W 88326 | Fa ee
[906]MWi:37243329 Page 12 é ; woes | ; -
[911]“-P0: ALL Staff Employees
[913]MEMORANDUM ©
[915]FROM: © Budget Officer
[917]DATE: January, 3, 1977
[919]| RE: | Payroll Certification
[921]- Starting: with the | January, 1977 payroll, “the certification
[923]to! the House Finance Office requires, among other things, the.
[924]- syelationship, if any, of each.staff employee to any current
[926]_ Member of Congress (those taking office January 3, 1977).
[932]The following are the relationships to be. included int
[934]~ father we ee re nephew aE “prother-inJaw
[936]mother 050 mire oo sister-in-law) 0.) |)
[937]gon husband stepfather
[939]daughter = Wife stepmother
[941]sister mother-in-law = stepsister _
[943]oe aunt fo -. daughter-in-law ot Ralf-sister —
[944]first cousin 7 Co . an : . er re
[948]- ; All staff ‘employees | are requested ‘to "complete this re ee
[949]-form and return it to. the Budget officer. ee
[951]- Approved
[953]*T am,not related ~
[955]“Richard A. Sprague
[957]“eT-am related by the following relationship _
[959]W 88326
[961]1d:32243329 Page 13 ; “he
[963]_ ‘Signat re of pmployee
[965]er
[967]pi Bi