[1]NW 88326 Docid:32739453 Page 1
[3]Assassination Records Review Board
[4]Final Determination Notification
[6]AGENCY : HSCA
[7]RECORD NUMBER : 180-10060-10445
[8]RECORD SERIES : STAFF PAYROLL RECORDS
[9]AGENCY FILE NUMBER :
[11]December 8, 1995
[12]Status of Document: Postponed in Part
[14]Number of releases of previously postponed information: 10
[16]Reason for Board Action: The Review Board's decision was premised on several factors
[17]including: (a) the significant historical interest in the document in question; (b) the
[18]absence of evidence that the release of the information would cause harm to the United
[19]States or to any individual.
[21]Number of Postponements: 9
[23]Postponements: All the postponements in this document represent Social Security numbers
[25]Reason for Board Action: The text 1s redacted because the public disclosure of the redaction could
[26]reasonably be expected to constitute an unwarranted invasion of personal privacy, and that invasion of
[27]privacy would be so substantial that it outweighs the public interest.
[29]Substitute Language: SSN
[31]Date of Next Review: 2017
[33]Board Review Completed: 10/24/95
[36]Date:08/20/93
[37]Page:1
[38]JFK ASSASSINATION SYSTEM
[40]IDENTIFICATION FORM
[42]AGENCY INFORMATION
[44]AGENCY : HSCA
[45]RECORD NUMBER : 180-10060-10445
[47]RECORDS SERIES :
[48]STAFF PAYROLL RECORDS
[50]AGENCY FILE NUMBER :
[52]DOCUMENT INFORMATION
[54]ORIGINATOR :
[55]FROM ;
[56]TO :
[57]TITLE :
[59]DATE
[60]PAGES
[62]12/01/76
[63]10
[65]SUBJECTS :
[66]HSCA, ADMINISTRATION
[67]HOWARTH, THOMAS
[69]DOCUMENT TYPE PRINTED FORM
[71]CLASSIFICATION : U
[72]RESTRICTIONS : 3
[73]CURRENT STATUS : P
[75]DATE OF LAST REVIEW : 06/04/93
[77]OPENING CRITERIA :
[79]COMMENTS
[81]Box 2.
[83](R] - ITEM IS RESTRICTED
[85]| NW 88326 Docld:32239453 Page 2
[89]PAYROLL AUTHORIZATION FORM we
[91](Please Use Typewriter US. HOUSE OF REPRESENTATIVES (Any erasures, corrections, or changes
[93]on this form must be initialed by the
[94]or Ballpoint Pen) Washington, D.C 20515 authorizing official )
[96]To the Clerk of the House of Representatives:
[98]{| hereby outhorize the following payroll action:
[100]Employee Name (First-Middle-Last)
[101]Thomas Howarth
[102]Employee Social Security Number
[103]B15-18-1 386
[104]Employing Office or Committee/Subcommittee
[106]Effective Date
[108]mbar 1, 1977
[109]Type of Action
[111]Dece
[113]O Appointment
[114]22] Salary Adjustment
[115]O Title Change
[117]Termination (At close of business on effective date)
[119]Assassinations
[121]D Leave without pay (Beginning with effective date above and ending
[122]close of business }
[124]Speafy Date
[126](If type of action is an Appointment, Salary Adjustment, or Title Change, complete appropriate information below.)
[128]Position Title
[130]Budget Officer
[132]Gross Annual Salary*
[134]* if employee is a civil service annuitant (includes US House of Representatives), the gross annual salary shown should include the annuity received by the employee
[135]plus the salary received from the employing office.
[137](If Committee Employee, complete appropriate item below }
[139].O ma Committee: Staff—O Clerical or 01 Professional.
[141]3. O) Joint Committee.
[143](If Employee of an Officer of the House, complete item below.)
[145]Position Number___.- = If applicable, Level
[147]Step_______.
[149]| certify that this authorization «is not in violation of 5 USE 3110(6), prohibiting the employment of
[150]relatives. ae “ wee
[154]fa
[156]r a ee
[158]December 7 77 . : _t a
[160]All appointments and salary adjustments for employees under the House Classification Act and for Committee em-
[161]ployees, except those of the Committee on Appropriations, the Committee on the.Budget, and the Joint Committees, must
[162]be approved by the Committee on House Administration
[164]APPROVED:
[166]Chairman, Committee on House Administration
[168]Office of Finance use only:
[170]Office Code
[172]we 88326 Docld:32239453 Page 3 rm
[174]' a
[175]Fe ne waders Ken abn send tt et ttle hha nttenan a ete taf et ot te Sonate
[179]j
[182]1
[183]4
[185]q
[186]i \
[187],)
[188]A
[190]1 we Ne
[193]1
[194]i
[195]i
[198],
[199]H co
[200]) \
[201]~ 4
[202]1
[203]’ 1
[207]a
[209]4
[211]A
[212]i
[213]4
[214]1
[219]PAYROLL AUTHORIZATION FFM
[221]4 {
[222](Please Use Typewriter = U.S. HOUSE OF REPRESENTATIVES . (Any erasures, corrections, or changes:
[224]on this form must be initialed by the
[225]or Ballpoint Pen) Washington, DC 20515 authorizing officral }
[227]To the Clerk of the House of Representatives:
[229]| hereby authorize the following payroll action.
[231]Effective Date |
[233]December 1, 1978 |
[234]Type of Action
[236]Employee Name (First-Middle-Last)
[238]Thomas Howarth
[240]Employee Social Security Number
[242]G15~18-1386
[244]Employing Office or Committee/Subcommittee
[246]O) Appointment
[247]© Salary Adjustment
[248]0 Title Change
[250]OD Termination (At close of business on effective date)
[252]C1 Leave without pay (Beginning with effective date above and ending
[254]close of business. == ee )
[255]Specify Date
[257](If type of action is an Appointment, Salary Adjustment, or Title Change, complete appropriate information below.)
[259]Position Title Gross Annual Salary*
[263]* If emoloyee 1s a civil service annuitant (includes U S House of Representatives), the gross annual salary shown should include the annuity received by the employee
[264]plus the salary received from the employing office
[266](If Committee Employee, complete appropriate item below } \
[267]1. 1 Standing Committee: Staff—O) Clerical or C1 Professional.
[269]2. Al Special (Investigative staff of Standing Committee} or Select Committee: Authority—H. Res225__ off 3E1 Congress.
[270]3. O Joint Committee.
[272]- (If Employee of an Officer of the House, complete item below.)
[274]Position Number
[276]| certify that this authorization is not in violation of 5 US.C 3110(b), prohibiting the employment of-
[278]relatives. a oe pany a et Senge .
[279]December il ele Na ee
[281]- (Signature of Authorizing Official}
[282]_ AOUIS STOKES
[283](if appropriate, signature of Subcommittee Chairman or Ranking Minority Member) = ~=S=S™*S*~S*~S*~*S*S*S*S*S” ype oe aint name of Authoraing Offer)
[284]“ Chairman
[286]All appointments and salary adjustments for employees under the House Classification Act and for Committee em- -
[288]ployees, except those of the Committee on Appropriations, the Committee on the Budget, and the Joint Committees, must
[289]be approved by the Committee on House Administration
[291]APPROVED:.___-. _
[292]. = Chairman, Committee on House Administration
[293]Office of Finance use only ID.
[294]Office Code... Benefits...
[295]Monthly Annuity $_._____ 200 asof_ Payroll.
[297]Copy for Initiating Office or Committee
[299]feb ata cathe Re ad asthe ad eee ell AA arnt lt
[303]Eee nT Trees OS OO OO OES aOR CONT Al OY SOO SPC SOT ALTO DOE SOT
[305]Paeren vine
[307]alee
[309]PAYROLL AUTHORIZATION FO"
[311](Please Use Typewriters
[312]or Ballpoint Pen)
[314]To the Clerk of the House of Representatives:
[316]“U.S. HOUSE OF REPRESENTATIVES
[317]Washington, D.C. 20515
[319](Any erasures, corrections, or changes
[320]on this form must be titialed by the
[321]authorizing official )
[323]4
[324]{ hereby authorize the following payroll action: 4
[326]Employee Name (First-Middle-Last) Effective Date 1
[327]Thomas Howarth Novemser 1, 1978 j
[328]4
[329]Employee Social Security Number Type of Action j
[330]a UO Appointment ;
[331]me
[332]. 015-186-1386 D Salary Adjustment i
[333]Employing Office or Committee/Subcommittee {3 Title Change 4
[334]3 0 Termination (At close of business on effective date) 2
[335]- Assassinations 0 Leave without pay (Beginning with effective date above and ending j
[336]close of business j
[337]Specify Date i
[338](If type of action is an Appointment, Salary Adjustment, or Title Change, complete appropriate information below.) i
[339]Position Title Gross Annual Salary * 4
[340]3
[342]beputy Staff Director & Budget Officer
[344]* If emoloyee is a civil service annuitant (includes U S House of Representatives), the gross annual salary shown should include the annuity received by the employee
[345]plus the salary received from the employing office
[347](If Committee Employee, complete appropriate item below }
[349]1. O Standing Committee: Staff—O Clerical or O Professional.
[351]hid ee we A
[353]. A ran
[355]2. [4 Special (Investigative staff of Standing Committee) or Select Committee: Authority—H. Res#2% of 38te ongress.
[357]- 3. O Joint Committee. ‘
[358](If. Employee of an Officer of the House, complete item below ) ;
[359]Position Number___._ If applicable, Level. Step_______. ° :
[360]1 certify that this authorization 1s not in violation of 5 U.S.C 3110(b), prohibiting-the employment of 4
[361]relatives _ ae ;
[362]- aoe
[364]Hoverber 13 78 ee er Ae :
[365]Date. we WE ae ee 4
[366]ae (Signature of Authorizing Official) 4
[367]a LOUTS SHORES j
[368]We appropriate, ‘signature of Subcommittee Chairman or Ranking Minority Member), — (Ups gr pant nae of Authoring Ofeo) i
[370]~n.
[372]All appointments and salary adjustments for employees under the House Classification Act and for Committee em- i
[373]ployees, except those of the Committee on Appropriations, the Committee on the Budget, and the Jot Committees, must q
[374]be approved by the Committee on House Administration 5
[376]APPROVED: _ 3
[378]Chairman, Committee on House Administration :
[380]4
[382]A
[384]Office of Finance use only: 4
[385]Office Code {
[387]4
[389]4
[391]« a
[392]1
[394]Copy for Initiating Office or Committee ;
[396]we 88326 Docld:32239453 Page 5
[398]PAYROLL AUTHORIZATION FORM
[400](Please Use Typewriter U.S. HOUSE OF REPRESENTATIVES . (Any erasures, corrections, or changes
[402]on this form must be tnitraled by the
[403]or Ballpoint Pen} Washington, DC 20515 authorizing offictal )
[405]To the Clerk of the House of Representatives:
[407]| hereby authorize the following payroll action
[409]Employee Name (First-Middle-Last)
[411]Effective Date
[413]Thomas Howarth 8/1/77
[415]Employee Social Security Number
[416]015-718-1386
[418]Employing Office or Committee
[420]Type of Action
[422][] Appointment
[424]C2 Salary Adjustment
[426]C1 Termination {At close of business on effective date)
[428]|
[430]Assassinations
[432](If type of action 1s an Appointment or Salary Adjustment, complete the following information)
[434]Position Title
[436]Gross Annual Salary
[438]Budget Officer
[440](If Committee Employee, complete appropriate item below.)
[442]1. LJ Standing Committee. Staff—(] Clerical or (J Professional
[444]2. [x] Special or Select Committee. Authority-H Res. 46% of 45¢h Congress
[446]3. [1] Joint Committee.
[448](If Employee of an Officer of the House, complete item below.)
[450]Position Number__~ If applicable, Level_
[452]; | certify that this authorization is not in violation of 5 USC. 3110(b), prohibiting the employment of
[453]relatives. ee ewe
[455]a se + peters en tate ee me ee
[457]Date____* A ugust 2 ee ee ; 1977 ee ae --- everommanetrmmrnes eT
[458]- Li we ke ra (Signature of Authorizing Official)
[459]eo LOUTS STOKES
[460]ype or print name of Authorumg Official]
[461]4 RHAIRMAN
[462]~~ Hitle=if Member, Dstrictond State) sStsSt=~<CS~S~S ~
[464]~~ All appointments and salary-adjustments for employees under the House. Classification Act and for*Committee emer’ * +
[466]ployees, except those of the Committee on Appropriations; the Committee: on the Budget, and the Joint Committees, must
[467]be approved by the ‘Committee on House Administration :
[469]APPROVED-
[471]Chairman, Committee on House Administration
[473]Office of Finance use only:
[474]Office Code
[476]law 88326 Docld:32239453 Page 6 rm
[481])
[483]|
[485]PAYROLL AUTHORIZATION FORM
[487](Please Use Typewriter - « U.S. HOUSE OF REPRESENTATIVES (Any erasures, corrections, or changes
[489]on this form must be initialed by the
[490]or Ballpoint Pen) Washington, DC 20515 authorizing official )
[492]To the Clerk of the House of Representatives:
[494]| hereby authorize the following payroll action:
[496]Effective Date . |
[497]5/29/77 |
[498]Type of Action ©
[500]Employee Name (First-Middie-Last)
[502]Thomas Kowarth
[503]Employee Social Security Number
[505]G15 18 1386
[507](1) Appointment
[509]Employing Office or Committee &) Sclary Adjustment
[511]Termination (At close of business on effective date)
[513]Assassinations
[515](If type of action is an Appointment or Salary Adjustment, complete the following information )
[517]Position Title | __ Gross Annual Salary
[521](If Committee Employee, complete appropriate item below.)
[523]1. LJ Standing Committee. Staff—[ Clerical or [7] Professional.
[525]3 [] Joint Committee.
[527](If Employee of an Officer of the House, complete item below)
[529]Position Number If applicable, Level
[531]| certify that this authorization is not in violation of. 5 U.S.C..-3110(b), prohibiting the employment of
[532]relatives hae ra oe
[534]it
[535]” ea
[537]feet o
[538]a gts a
[539]2 age see Oe aa
[540]eof a are
[541]can
[543]i
[544]i
[545]it
[547]Dote._-- May 10 i9f7 £
[548]0 Ie ature of Authorizing Offell
[549]Louis Stokes
[550]pe rype or print name of Authonaing Official) =
[551]x Chairman ;
[553].- All appointments and salary adjustments for employees under the House Classification Act and for Committee em-
[555]hw 88326 Docld:32239453 Page f :
[557]Mee te yh * D
[558]lve tei irate ata aaah Sean washes bee eee afer,
[560]Toews Lond
[562]t é
[564]see atibetion a Dat El eaie 4
[568]to
[570]ployees, except those of the Committee on Appropriations, the Committee on the Budget, and the Joint Committees, must ~~ 3
[572]be approved by the Committee on House Administration 4
[573]APPROVED:.__-- _
[575]Chairman, Committee on House Administration :
[577]Office of Finance use only 7
[579]i
[581]Office Code__________ Jl i
[583]Monthly Annuity $_.______—_--00 fp;
[585]4
[587]Copy for Initiating Office or Committee i
[589]— we -e ee eee ee 2 _ eee _ -oe ne
[591]————_I
[593]PAYROLL AUTHORIZATION FORM
[595](Please Use Typewriter U.S. HOUSE OF REPRESENTATIVES (Any erasures, corrections, or changes
[597]on this form must be initialed by the
[598]or Ballpoint Pen) Washington, DC 20515 authorizing official )
[600]To the Clerk of the House of Representatives:
[602]| hereby authorize the following payroll action
[604]Employee Name (First-Middle-Last)
[605]Thomas Howarth
[607]Effective Date
[609]A/i/77
[611]Employee Social Security Number Type of Action
[613]O15 18 1386
[615](> Appointment
[617]Employing Office or Committee DSclary Adjustment
[619]Termination (At close of business on effective date)
[621]Assassinations
[623]7
[625](If type of action is an Appointment or Salary Adjustment, complete the following information )
[627]Position Title | Gross Annual Salary
[631](If Committee Employee, complete appropriate item below }
[633]1 (J Standing Committee. Staff—[J] Clerical or [] Professional
[635]2. [4] Special or Select Committee Authority—H. Res 465 of 25th Congress
[637]3. J Joint Committee.
[639](If Employee of an Officer of the House, complete ttem below.)
[641]Position Number If applicable, Level
[643]| certify that this authorization is not in violation of 5 USC. 3110(b), prohibiting the employment of
[644]relatives. _
[646]a
[647].. y, enn
[648]Date _ Apri 23 of? oc phe OO _
[649]BE Bee mer aa (Signature of Authorizing Official) rs
[650]_kouis Stokes
[652](Type or print name of Authorizing Official)
[654]a Chairman
[656]All appointments and salary adjustments for employees under the House Classification Act and for Committee em-
[658]ployees, except those of the Committee on Appropriations, the Committee on the Budget, and the Joint Committees, must
[659]be approved by the Committee on House Administration
[661]APPROVED.
[663]Chairman, Committee on House Administration
[665]Office of Finance use only:
[667]Office Code
[669]Copy for Initiating Office or Committee
[671]NW 88376 Docid:34939453 Page 8 : ror
[673]SEY POCIEC OE TOON OPE EEE NNTP LORIN OTT, VO TO a
[675]ee tae il UA A ete i Ha has eat dea! tne
[677]Ba cents che Hd a Pe
[679]pie ene ed cant Lane inflate
[681]Grneti oe 6 cae kell eaten eantltede ee te
[683]we
[685]PAYROLL AUTHORIZATION FORM
[687](Please Use Typewriter U.S. HOUSE OF REPRESENTATIVES v (Any erasures, corrections, or changes
[689]on this form must be initialed by the
[690]or Ballpoint Pen) Washington, DC 20515 authorizing official )
[692]To the Clerk of the House of Representatives:
[694]| hereby authorize the following payroll action
[696]Employee Name (First-Middle-Last) ; Effective Date
[697]Thomas Howarth
[699]Employee Sociai Security Number Type of Action
[700]015-18-1386 Appointment
[702]Employing Office or Committee - [Salary Adjustment
[704][] Termination (At close of business on effective date)
[706]Selact Committee on Assassinations
[708](If type of action 1s an Appointment or Salary Adjustment, complete the following information )
[710]Position Title Gross Annual Salary
[712]$18,450.
[714](If Committee Employee, complete appropriate ttem below.)
[716]1. [J Standing Committee. Staff—[_] Clerical or [7] Professional
[718]2. kal Special or Select Committee Authority—H pest ot_ Congress
[719]3. [J Joint Committee
[720](If Employee of an Officer of the House, complete item below.) °
[722]Position Number If applicable, Level _ Step__
[724]| certify that this authorization is. not in violation of 5 USC .3110(b), prohibiting the employment of
[725]relatives.
[727](Signature of Authorizing Official)
[729]Henry 8. Gonzalez
[731]- (Type or print name of Authorizing Official)
[732]Chairman
[734](Title—1f Member, District and State)
[736]- All appointments and salary adjustments for employees under the+House Classification Act and for Committee em-
[738]'. ployees, except those of.the Committee.on Appropriations, the Committee on the Budget, and the JointsCommittees, must
[740]be approved by the: Committee on House Administration~ -..
[742]APPROVED:
[744]Chairman, Committee on House Administration
[746]Office of Finance use only
[747]Office Code
[749]Copy for Initiating Office or Committee
[751]NW 88326 Docid:32739453 Page 3 r
[753]. . . .
[754]Ce aaa he A a LB geile alee ob enttlisee  ombetdiad Lite De telat at tel. Mate ant wtaatied Lenlidadat 1 Blenadlnandettabiadln bate Mil te tthalad Een anne AONE Ret Patella tnt eli Lida a ls ale set,
[756]he
[758]PAYROLL AUTHORIZATION FORM
[760]Pao
[761]{Please Use Typewriter
[762]or Ballpoint Pen) authorizing official )
[763]t ) ~ °
[764]To the Clerk of the House of Representatives:
[766]. [hereby authorize the following payroll action.
[768]Employee Name (First-Middie-Last) ‘ \ 7
[770]5
[772]Effective Date
[774]} ; rf 1
[775]. (A ' tions, h
[776]¢ \/US. HOUSE OF REPRESENTATIVES "(An sree, corectons or sane
[778]Taowas towarth
[780]co W377
[781]Empfoyee ‘Social Security Number
[783]Type of Action >
[784]Po a --
[785]O15 75 738c : ° Appointment
[786]Employing Office or Committee f.| Salary Adjustment - _
[787]‘ Select Committee on Assassinations Oo
[789]Termination (At close of business on effective date)
[791](If type of action 1s an Appointment or Salary Adjustment, complete the following information )
[793]; “Position Title
[795]Gross Annual Salary
[799]nell
[800]2
[802]pir)
[803]“a
[805]If Committee Employee, complete appropriate item below }
[807]5
[808]1 (J Standing Committee. Staff—
[809]2 y
[811]Clerical or [-] Professional.
[813]- a oar
[814]Special or Select Committee. Authority—H Res __© " of sth
[816]3. [ Jomnt Committee :
[818](If Employee of an Officer of the House, complete item below.)
[820]Position Number
[822]| certify that this authorization is not in violation of 5 USC 3110(b), prohibiting the employment of
[823]relatives
[826]Date. 198F oe
[827]“— (Signature of Authorizing Official)
[828]Henry B. Sonzaler
[829]ee Type or printname of Authorizing Offical)
[830]. Chairman —
[831]f -
[833]~Tritle IF Member, District and State) eee ~
[835]All appomtments and salary adjustments for employees under the House Classification Act and for-Committee em-
[837]ployees, except those of the Committee on Appropriations, the Committee on the Budget, and the Joint Committees, must
[838]be approved by the Committee on House Administration
[840]APPROVED - ~
[842]Chairman, Committee on House Administration
[844]Office of Finance use only:
[846]‘ Office Code
[850]Copy for Iniitating Office or Committee
[852]NW 88326 Docid:32739453 Page 10
[854]te
[856]PAYROLL AUTHORIZATION FORM, os
[857]tos (Please Use Typewriter ‘ J U. §. HOUSE OF. REPRESENTATIVES ._- (Any. erasures, corrections, or changes
[859]or Ballpoint Pen) Washington;-D C* 20515 on this form must ye imtialed by the
[861]To the Clerk of the House of Representatives:
[863]| hereby authorize the following payroll action.
[865]NN
[867]- 7
[868]Employee Name (First-Middle-Last) Effective Date
[869]7 Thomas Howarth . 92/7/76
[870]: Employee Social Security Number Type of Action
[871]O15 15 1326 it] Appointment , _ ;
[872]Employing Office or Committee [Salary Adjustment _ )
[873]_ | Termination (At close of business on effective date)
[875]|. Select Sosittes on Assassinations |
[877](If type of action.1s an Appointment or Salary Adjustment, complete the following information )
[879]; Position Title Gross Annual Salary a 7
[880]gudget Officer | $30,000 —
[882](If Committee Employee, complete appropriate item below )
[884]. 1 Standing Committee Staff—[_! Clerical or (_] Professional.
[886]23] Special or Select Committee Authority—H Res 1540 _. of 44h Congress
[888]r
[890]3 Joint Committee.
[892](If Employee of an Officer of the House, complete ttem below) «
[894]Position Number If applicable, Level
[896]Step_______-
[898]1 certify -that this- authorization 1s not. in ‘violation , of 5 USC 3110(b), prohibiting the employment of
[899]relatives
[901](Signature of Authorizing Official)
[903]Thomas f. Bownfng, Chairaan
[905](Type or print name of Authorizing Official)
[907]‘ _ Select Committee on Assassinations
[909]All appointments and salary adjustments for.employees under the House Classification Act and for Committee em-
[911]- + ployees, except those of the Committee on Appropriations; the Committee-on the Budget, and the-Joint Committees, must
[912]be approved by the Committee on House Administration ~ .
[914]wee . APPROVED
[916]Chairman, Committee on House Administration
[918]NW 88326 Docid:32739453 Page 17 , ro
[920]pe her
[922]|
[924]|
[926]. C O}
[928]MEMORANDUM
[930]TO: All Staff Employees
[931]FROM: Budget Officer
[932]DATE: January 3, 1977
[934]RE: Payroll Certification
[936]Starting with the January, 1977 payroll, the certification
[937]to the House Finance Office requires, among other things, the
[938]relationship, if any, of each staff employee to any current’
[939]Member of Congress (those taking office January 3, 1977).
[941]The following are the relationships to be included in
[942]the certification:
[944]father nephew brother-in-law |
[945]mother niece sister-in-law i
[946]son husband stepfather |
[947]“daughter wife stepmother
[949]brother father-in-law stepbrother
[951]sister mother-in-law stepsister
[953]uncle son-in-law half-bi other j
[954]aunt daughter-in-law half-sister i
[956]first cousin |
[958]All staff employees are requested to complete this
[959]form and return it to the Budget officer.
[961]Approved
[962]Richard A. Sprague
[964]I am not related
[966].I-am related by the following relationship
[968]Se
[970]Signature of Employee
[972]| 88326 Docld:32239453 Page 12 ‘ r ~
[974]pee She