Assassination Records Review Board
Final Determination Notification
AGENCY : HSCA
RECORD NUMBER :
180-10060-10468
RECORD SERIES : STAFF PAYROLL RECORDS
AGENCY FILE NUMBER :
December 8, 1995
Status of Document:
Postponed in Part
Number of releases of previously postponed information: 14
Reason for Board Action: The Review Board's decision was premised on several factors
including: (a) the significant historical interest in the document in question; (b) the
absence of evidence that the release of the information would cause harm to the United
States or to any
individual.
Number of Postponements: 10
Postponements: All the postponements in this document represent Social Security numbers.
Reason for Board Action: The text is redacted because the public disclosure of the redaction could
reasonably be expected to constitute an unwarranted invasion of personal privacy, and that invasion of
privacy would be so substantial that it outweighs the public interest.
Substitute Language: SSN
Date of Next Review: 2017
Board Review Completed: 10/24/95
NW 88326
Docld:32239476 Page 1
Released under the John F.
Kennedy Assassination
Records Collection Act of
1992 (44 USC 2107 Note).
Case#:NW 88326 Date:
2025
५
13
JFK ASSASSINATION SYSTEM
IDENTIFICATION FORM
AGENCY INFORMATION
Date: 08/20/93
Page: 1
AGENCY: HSCA
RECORD NUMBER :
180-10060-10468
RECORDS SERIES :
STAFF PAYROLL RECORDS
AGENCY FILE NUMBER :
ORIGINATOR : HSCA
FROM:
TO :
TITLE :
DOCUMENT INFORMATION
DATE : 12/06/76
PAGES: 16
SUBJECTS :
HSCA, ADMINISTRATION
LEHNER, ROBERT
DOCUMENT TYPE :
CLASSIFICATION
RESTRICTIONS :
PRINTED FORM
:
U
3
CURRENT STATUS : P
DATE OF LAST REVIEW : 06/04/93
OPENING CRITERIA :
COMMENTS :
Box 2.
[R] ·
-
ITEM IS RESTRICTED
NW 88326
Docld:32239476 Page 2
C
LEHNER, Robert
Name of Employee
Address
Address
Phone Number
Position Titia
С
OFFICE OF THE CLERK
U.S. HOUSE OF REPRESENTATIVES:
PERSONAL LEAVE RECORD
1978
YEAR
BALANCE BROUGHT
FORWARD FROM
PRECEDING YEAR
Annual
Leave
Sick
Leave
ANNUAL LEAVE
DATE OF APPOINTMENT
CATEGORY
12-6-76
1.0
1.5
PRIOR FEDERAL SERVICE
2,0
Years
Months
12 13
ACCRUED
Position Number
Level
Step
DAY OF MONTH
THIS MONTH
AVAILABLE
THIS MONTH
USED
THIS MONTH
BALANCE
AT CLOSE
OF MONTH
Menth
3
3
7
3
9
10 11
12 13
14
15 16 17 18 19
20
21 22 23
24 25
20 27 28
Annual. Sick
Leave
29 30 31 Leave
Annual
Leave
Sick
Leave
Annual Sick
Leave
Leave
Annual
Leave
Sick
Leave
☑
P
13 14 7
14
Jan.
Fcb.
Mar.
Apr.
May
June
July
Aug.
Sept.
Oct.
Nov.
Dec.
33.03
CERTIFIED CORRECT:
Includes & days
annual leave and
bama adm. leave
Chief's Signature
=0.5 day annual leave
= 1.0 day annual leave
=0.5 day sick leave
= 1.0 day sick leave.
= 0.5 day administrative leave
Terminated 2/28/78
Employee's Signature
Dutc
(If employee refuses to sign, state reason below.
A
or
= 1.0 day administrative leave
INDNE
.
= 0.5 day unauthorized absence,
or
1.0 day unauthorized absence.
= 0.5 day leave without pay.
= 1.0 day leave without pay
NW 88326
Docid:32239476 Page 3
Approved:
Clerk of the House
Dato
INITIALS
This record will be forwarded to the Clerk of the House at the end of each calendar year, or in case of termination, along
with the request for termination. Upon approval, the record will be filed in the employee's official personnel folder.
EXHIBIT I
LOUIS STOKES, OHIO, CHAIRMAN
RICHARDSON PREYER, N.C..
SAMUEL L. DEVINE, OHIO
WALTER E. FAUNTROY, D.C.
YVONNE BRATHWAITE BURKE, CALIF.
CHRISTOPHER J. DODD, CONN.
HAROLD E. FORD, TENN.
FLOYD J. FITHIAN, IND.
STEWART B. MCKINNEY, CONN.
CHARLES THONE, NEBR.
HAROLD S. SAWYER, MICH.
ROBERT W. EDGAR, PA.
(202) 225-4624
Select Committee on Assassinations
U.S. House of Representatives
3331 HOUSE OFFICE BUILDING, ANNEX 2
WASHINGTON, D.G. 20515
September 19, 1978
U. S. Department of Justice
Personnel Room 6248
10th & Pennsylvania Avenue, N. W.
Washington, D. C. 20530
Personnel Office:
Attention: Susan Reneer
In resonse to your telephone inquiry, we are verifying the
following information on Robert J. Lehner.
TH:ht
NW 88326
Docid:32239476 Page 4
Appointed:
December 6, 1976
Teminated:
February 28, 1978
Salary:
$45,500.00
Sincerely your's,
yours
Thomas Howart!
THOMAS HOWARTH
Budget Officer
PAYROLL AUTHORIZATION FOR
(Please Use Typewriter
or Ballpoint Pen)
U.S. HOUSE OF REPRESENTATIVES
Washington, D.C. 20515
To the Clerk of the House of Representatives:
I hereby authorize the following payroll action:
Employee Name (First-Middle-Last).
Robert J. Lehner
(Any erasures, corrections, or changes
on this form must be initialed by the
authorizing official.)
Effective Date
February 28, 1978
Type of Action
☐ Salary Adjustment
Employee Social Security Number
071-28-5111
☐ Appointment
Employing Office or Committee/Subcommittee
Select Committee on Assassinations
☐ Title Change
☐ Termination (At close of business on effective date)
☐ Leave without pay (Beginning with effective date above and ending
close of business_
Specify Date
(If type of action is an Appointment, Salary Adjustment, or Title Change, complete appropriate information below.) ·
Position Title
Gross Annual Salary*
* 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.
879 95th
Special (Investigative staff of Standing Committee) or Select Committee: Authority-H. Res._. of 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
relatives.
February 16,
Date __
78
19.
(If appropriate, signature of Subcommittee Chairman or Ranking Minority Member)
(Type or print name and title of above official)
(Signature of Authorizing Official)
Louis Stokes
(Type or print name of Authorizing Official)
Chaffman
(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, must
be approved by the Committee on House Administration.
Office of Finance use only:
APPROVED:
Chairman, Committee on House Administration
ID
Office Code ___
Benefits
Monthly Annuity $_
.00
as of
Payroll
Copy for Initiating Office or Committee
(Revised: August 1
19771
NW 88326
Docid:32239476 Page 5
MEMORANDUM
TO:
FROM:
DATE:
Thomas Howarth, Budget Officer
1V.em
I. Charles Mathews, Special Counsel
February 14, 1978
RE:
Mr. Robert Lehner
Effective Tuesday, February 28, 1978, Robert Lehner
will be terminated from the Committee payroll.
If you have any questions concerning this matter,
please contact me at your convenience.
ICM:j
NW 88326
Docld:32239476 Page 6
eb
PAYROLL AUTHORIZATION FORM
(Please Use Typewriter
or Ballpoint Pen)
_U.S. HOUSE OF REPRESENTATIVES
Washington, D.C. 20515
To the Clerk of the House of Representatives:
I hereby authorize the following payroll action: bes
Employee Name (First-Middle-Last)
(Any erasures, corrections, or changes
on this form must be initialed by the
"authorizing official.)
Robert J. Lehner
Employee Social Security Number
071-28-511]
Employing Office or Committee
Effective Date
December 1, 1977
Type of Action
Appointment
Assassinations
Salary Adjustment
Termination (At close of business on effective date)
(If type of action is an Appointment or Salary Adjustment, complete the following information.)
Position Title
Deputy Chief Counsel
(If Committee Employee, complete appropriate item below.) pa na
☐ Standing Committee: Staff ☐ Clerical or ☐ Professional w
Gross Annual Salary
$45,500
2. Special or Select Committee: Authority H. Res. 465 of 95th Congress.
3. ☐ Joint Committee. That der pet
(If Employee of an Officer of the House, complete item below.) val venerde quatrauk
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
relatives.
Date_
December 1
1977
(Signature of Authorizing Official):
Louis Stokes
(Type or print name of Authorizing Official)
Chairman
(Title If Member, District and State)
All appointments and salary adjustments for employees under the House Classification Act and for Committee rem-
ployees, except those of the Committee on Appropriations, the Committee on the Budget, and the Joint Committees, must
be approved by the Committee on House Administration
Office of Finance use only:
Office Code...
Monthly Annuity $.
.00
NW 88326
Docld:32239476 Page 7
APPROVED:
Chairman, Committee on House Administration
Copy for Initiating Office or Committee
PAYROLL AUTHORIZATION FORM
(Please Use Typewriter
or Ballpoint Pen)
U.S. HOUSE OF REPRESENTATIVES
Washington, D.C. 205.15
To the Clerk of the House of Representatives:
I hereby authorize the following payroll action:
Employee Name (First-Middle-Last)
Robert J. Lehner
(Any erasures, corrections, or changes
on this form must be initialed by the
authorizing official.)
Effective Date
8/1/77
Employee Social Security Number
Type of Action
071-28-5111
Appointment
Employing Office or Committee
Assassinations
Salary Adjustment
Termination (At close of business on effective date)
(If type of action is an Appointment or Salary Adjustment, complete the following information.)
Position Title
Deputy Chief Counsel
(If Committee Employee, complete appropriate item below.).
1. ☐ Standing Committee: Staff -☐ Clerical or ☐ Professional.
Gross Annual Salary
42,500
2. Special 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
relatives.
Date
August 2
19.77
(Signature of Authorizing Official)
LOUIS STOKES
(Type or print name of Authorizing Official)
CHAIRMAN
(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, must-
be approved by the Committee on House Administration
Ange
Office of Finance use only:
Office Code..
Monthly Annuity $
.00
NW 88326
Docld:32239476 Page 8
APPROVED:
Chairman, Committee on House Administration:
Copy for Initiating Office or Committee
PAYROLL AUTHORIZATION FORM
(Please Use Typewriter U.S. HOUSE OF REPRESENTATIVES
or Ballpoint Pen):
Washington, D.C. 20515
To the Clerk of the House of Representatives:
I hereby authorize the following payroll action:
(Any erasures, correction's, or changes
on this form must be initialed by the
authorizing official.)
Employee Name (First-Middle-Last)
Robert J. Lehner
Employee Social Security Number
071 28 5117
Employing Office or Committee
Assassinations
Effective Date
7/77/77
Type of Action
Appointment
☑ Salary Adjustment
Termination (At close of business on effective date)
(If type of action is an Appointment or Salary Adjustment, complete the following information.)
Position Title
Gross Annual Salary:
$36,000
of 95th
Congress.
(If Committee Employee, complete appropriate item below.).
Standing Committee: Staff -☐ Clerical or ☐ Professional.
2. ☑Special or Select Committee: Authority-H. Res...
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
relatives.
Date
July 14
1977
(Signature of Authorizing Official)
Louis Stokes
(Type or print name of Authorizing Official)
Chairman
(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, must
be approved by the Committee on House Administration.
Office of Finance use only:
Office Code.
Monthly Annuity $__
.00
NW 88326
Docid:32239476 Page 9
APPROVED:
Chairman, Committee on House Administration
Copy for Initiating Office or Committee
HA Comm.
7/15/77
U.S. GOVERNMENT PRINTING OFFICE: 1977-80-199
PAYROLL AUTHORIZATION FORM
(Please Use Typewriter
or Ballpoint Pen)
U.S. HOUSE OF REPRESENTATIVES
Washington, D.C. 20515
To the Clerk of the House of Representatives:
I hereby authorize the following payroll action:
Employee Name (First-Middle-Last)
Robert J. Lehner
(Any erasures, corrections, or changes
on this form must be initialed by the
authorizing official.)
Effective Date
7/17/77
Type of Action
Employee Social Security Number
071 28 5111
☐ Appointment
Employing Office or Committee
☑ Salary Adjustment
Termination (At close of business on effective date)
Assassinations
(If type of action is an Appointment or Salary Adjustment, complete the following information.)
Position Title
Gross Annual Salary
* $36,000
(If Committee Employee, complete appropriate item below.)/
1. ☐ Standing Committee: Staff-☐ Clerical or ☐ Professional.
2. ☑ Special or Select Committee: Authority-✓. Res. 465 of 95th Congress.
3. ☐ Joint Committee.
(If Employee of an Officer of the House, complete item below.)
7 -8 -77 [N 3:07
HoF 2. FINANCE OFFIC
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
relatives.
Date__
May 10 1977
(Signature of Authorizing Official)
Louis Stokes
(Type or print name of Authorizing Official)
Chairman
(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, must
be approved by the Committee on House Administration.
Office of Finance use only:
Office Code
Monthly Annuity $_
NW 88326-
Docld:32239476 Page 10
ARIAINLAN
.00
APPROVED:..
Chairman, Committee on House Administration

PAYROLL AUTHORIZATION FORM
(Please Use Typewriter
or Ballpoint Pen)
U.S. HOUSE OF REPRESENTATIVES
Washington, D.C. 20515
To the Clerk of the House of Representatives:
I hereby authorize the following payroll action:
Employee Name (First-Middle-Last)
(Any erasures, corrections, or changes
on this form must be initialed by the
authorizing official.)
Effective Date
Robert J. Lehner
7/77/77
Employee Social Security Number
Type of Action
071 28 5111
Appointment
Employing Office or Committee
Salary Adjustment
Assassinations
Termination (At close of business on effective date)
(If type of action is an Appointment or Salary Adjustment, complete the following information.)"
Position Title
Gross Annual Salary.
% $36,000
. (If Committee Employee, complete appropriate item below.):
1. ☐ Standing Committee: Staff-☐ Clerical or ☐ Professional.
2. ☑Special 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_
A certify that this authorization is not in violation of 5 U.S.C. 3110(b); prohibiting the employment of
relatives.
Date
May 10 1977
(Signature of Authorizing Official)
Louis Stokes
(Type or print name of Authorizing Official)
Chairman
(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 must
be approved by the Committee on House Administration. barbers
Office of Finance use only:
Office Code.
Monthly Annuity $_._
.00.
NW 88326
Docid:32239476 Page 11
APPROVED:
Chairman, Committee on House Administration
Copy for Initiating Office or Committee
2011
PAYROLL AUTHORIZATION FORM
(Please Use Typewriter
or Ballpoint Pen)
U.S. HOUSE OF REPRESENTATIVES
Washington, D.C. 20515
To the Clerk of the House of Representatives:
I hereby authorize the following payroll action:
Employee Name (First-Middle-Last)
(Any erasures, corrections, or changes
on this form must be initialed by the
authorizing official.)
Effective Date
Robert J. Lehner
4/7/77
Employee Social Security Number
Type of Action
071 28 5111
Appointment
Employing Office or Committee
Salary Adjustment
Assassinations
Termination (At close of business on effective date)
(If type of action is an Appointment or Salary Adjustment, complete the following information.)
Position Title
Gross Annual Salary
$47,500
(If Committee Employee, complete appropriate item below.) ·
1. ☐ Standing Committee: Staff -☐ Clerical or ☐ Professional.
2. ☑ Special 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
relatives.
Date
April 29
19_77
(Signature of Authorizing Official)
Louis Stokes
(Type or print name of Authorizing Official)
Chairman
(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, must
be approved by the Committee on House Administration.
Office of Finance use only:
Office Code..
Monthly Annuity $_.
.00
NW 88326
Docld:32239476 Page 12
APPROVED:..
· Chairman, Committee on House Administration
Copy for Initiating Office or Committee
PAYROLL AUTHORIZATION FORM
(Please Use Typewriter.
or Ballpoint Pen)
U.S. HOUSE OF REPRESENTATIVES
Washington, D.C. 20515
To the Clerk of the House of Representatives:
I hereby authorize the following payroll action:
Employee Name (First-Middle-Last)
(Any erasures, corrections, or changes
on this form must be initialed by the
authorizing official.)
Effective Date
Robert J. Lehner
2-1-77
Employee Social Security Number
Type of Action
071-28-5117
Appointment
Employing Office or Committee
Salary Adjustment
Select Committee on Assassinations
Termination (At close of business on effective date)
(If type of action is an Appointment or Salary Adjustment, complete the following information.)
Position Title
(If Committee Employee, complete appropriate item below.)
Gross Annual Salary
$22,140.
1. ☐ Standing Committee: Staff -☐ Clerical or ☐ Professional.
11
95
箕
2. Special or Select Committee: Authority-H. Res. ___ of_
3. ☐ Joint Committee.
_Congress.
(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
relatives.
Date
2-28-77
19
(Signature of Authorizing Official)
Henry B. Gonzalez
(Type or print name of Authorizing Official)
Chairman
(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, must
be approved by the Committee on House Administration.
Office of Finance use only:
Office Code
Monthly Annuity $...
.00.
NW 88326
Docld:32239476 Page 13
APPROVED:
Chairman, Committee on House Administration
Copy for Initiating Office or Committee.
GPO 1975 O-57-255
PAYROLL AUTHORIZATION FORM
(Please Use Typewriter
or Ballpoint Pen)
U.S. HOUSE OF REPRESENTATIVES
Washington, D.C. 20515.
To the Clerk of the House of Representatives:
Thereby authorize the following payroll action:
Employee Name (First-Middle-Last)
(Any erasures, corrections, or changes
on this form must be initialed by the
authorizing official.)
Robert J. Lehner
Employee Social Security Number
071 28 5111
Employing Office or Committee
Effective Date
1/3/77
Type of Action
Appointment
Salary Adjustment
Termination (At close of business on effective date)
Select Committee on Assassinations
(If type of action is an Appointment or Salary Adjustment, complete the following information.)
Position Title
Gross Annual Salary
$23.400.
(If Committee Employee, complete appropriate item below.)
1. ☐ Standing Committee: Staff -☐ Clerical or ☐Professional.
2. Special or Select Committee: Authority-H. Res. 11-
3. ☐ Joint Committee.
of 5-
Congress.
(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
relatives.
Date
177
(Signature of Authorizing Official)
Henry B. Gonzalez
Chairman
(Type or print name of Authorizing 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, must
be approved by the Committee on House Administration.
Office of Finance use only:
NW 88326
Office Code:
Code
Monthly Annuity $
Docld:32239476 Page 14
.00
APPROVED:
Chairman, Committee on House Administration
Copy for Initiating Office or Committee
PAYROLL AUTHORIZATION FORM
(Please Use Typewriter
or Ballpoint Pen)
U.S. HOUSE OF REPRESENTATIVES
Washington, D.C: 20515
To the Clerk of the House of Representatives:
I hereby authorize the following payroll'action:
Employee Name (First-Middle-Last)
(Any erasures, corrections, or changes
on this form must be initialed by the
authorizing official.)
Effective Date
Robert Joseph Lehner,
12/6/76
Employee Social Security Number
071 28 5111
☐ Appointment
Employing Office or Committee
Salary Adjustment
Type of Action
Termination (At close of business on effective date)
Select Committee on Assassinations
(If type of action is an Appointment or Salary Adjustment, complete the following information.)
Position Title
Deputy Chief Counsel
(If Committee Employee, complete appropriate item below.)
1. ☐ Standing Committee: Staff -☐ Clerical or ☐ Professional.
2. ☑Special or Select Committee: Authority-H. Res. 1540
3. ☐ Joint Committee.
4. (If Employee of an Officer of the House, complete item below.).
Position Number.
If applicable, Level_
Gross Annual Salary
$36,000
of 4th Congress.
Step_
堂
I certify that this authorization is not in violation of 5 U.S.C. 3110(b), prohibiting the employment of
relatives.
Date
December 2
1976
(Signature of Authorizing Official)
Thomas N. Downing, Chairman
(Type or print name of Authorizing Official)
Select Committee on Assassinations
(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 must
be approved by the Committee on House Administration..
Office of Finance use only:
Office Code.
Monthly Annuity $__
.00
NW 88326
Docid:32239476 Page 15
APPROVED:
Chairman, Committee on House Administration
Copy for Initiating Office or Committee
MEMORANDUM
TO:
All Staff Employees
FROM:
Budget Officer
DATE:
January 3, 1977
RE:
Payroll Certification
Starting with the January, 1977 payroll, the certification
to the House Finance Office requires, among other things, the
relationship, if any, of each staff employee to any current
Member of Congress (those taking office January 3, 1977).
The following are the relationships to be included in
the certification:
father
mother
nephew
niece
brother-in-law
sister-in-law
son
daughter
brother
sister
uncle
aunt
first cousin
husband
wife
father-in-law
mother-in-law
son-in-law.
daughter-in-law
stepfather
stepmother
stepbrother
stepsister
half-brother
half-sister
All staff employees are requested to complete this
form and return it to the Budget officer.
Approved
Richard A. Sprague
I am not related
I am related by the following relationship
signature of Employee
NW 88326
Docid:32239476 Page 16
January 24/1977