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# PAYROLL AUTHORIZATION FORM(Please Use Typewriteror Ballpoint Pen)U.S. HOUSE OF REPRESENTATIVESWashington, D.C. 20515(Any erasures, corrections, or changeson this form must be initialed by theauthorizing official )To the Clerk of the House of Representatives:I hereby authorize the following payroll action:| Employee Name (First-Middle-Last)          | Effective Date                                                                                                                                                                    || ------------------------------------------ | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- || Margo E. Jackson                           | December 1, 1977                                                                                                                                                                  || Employee Social Security Number            | Type of Action                                                                                                                                                                    || 437-92-5320                                | ☐ Appointment<br>☑ Salary Adjustment<br>☐ Title Change                                                                                                                            || Employing Office or Committee/Subcommittee | ☐ Termination (At close of business on effective date) <br>☐ Leave without pay (Beginning with effective date above and ending close of business ________ Specify Date__________) || Assassinations                             |                                                                                                                                                                                   |(If type of action is an Appointment, Salary Adjustment, or Title Change, complete appropriate information below.)| Position Title | Gross Annual Salary* || -------------- | -------------------- || Document Clerk | $15,000              |* 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  plus the salary received from the employing office.(If Committee Employee, complete appropriate item below)1. ☐ Standing Committee: Staff ☐ Clerical or ☐ Professional.2. ☑ Special (Investigative staff of Standing Committee) or Select Committee: Authority—H. Res. 465 of 95th Congress.3. ☐ Joint Committee.(If Employee of an Officer of the House, complete item below.)Position Number ________ If applicable, Level ________ Step ________I certify that this authorization is not in violation of 5 U.S C-3110(b), prohibiting the employment of relativesDate December 1, 1977Louis Stokes(Signature of Authorizing Official)eb(If appropriate, signature of Subcommittee Chairman or Ranking Minority Member) (Type or print name of Authorizing Official)(Type or print name and title of above official) (Title If Member, District and State)All appointments and salary adjustments for employees under the House Classification Act and for Committee em-ployees, except those of the Committee on Appropriations, the Committee on the Budget, and the Joint Committees, mustbe approved by the Committee on House AdministrationAPPROVED:Chairman, Committee on House AdministrationOffice of Finance use only:Office Code __________ID _________Benefits _________Monthly Annuity $__________.00 as of __________Payroll _________ (Revised August 1, 1977)Copy for Initiating Office or CommitteeNW 88326 Docld:32239457 Page 5