**Exhibit10.7**

**KEY OFFICER AGREEMENT**

**THIS AGREEMENT** (“Agreement”) ismade and entered into as of Oct. 12, 2005, by and between STEVEN M. ORESKOVICH(the “Executive”) and MERGE TECHNOLOGIES INCORPORATED, a Wisconsin corporation(the “Company”).

**R E C I T A L S :**

A.            TheCompany is engaged in the provision of medical diagnostic imaging software andprofessional services for healthcare facilities and medical equipmentmanufacturers. The business in which the Company is engaged in fromtime-to-time during the term of this Agreement, inclusive of those new lines ofbusiness, if any, in which the Company is working toward entering fromtime-to-time are hereinafter collectively referred to as the “Business”; and

B.            TheCompany employs the Executive and wishes to provide the Executive with benefitsin the event of severance or a change in control in exchange for Executive’sagreement with respect to competition, confidentiality, inventions, secrecy andretention of property in the event of such termination of employment;

NOW THEREFORE, in consideration of the promises,mutual covenants and agreements contained herein, and for other good andvaluable consideration, the receipt and sufficiency of which are herebyacknowledged, the Company and the Executive do hereby agree as follows:

# 1.             Disability Benefit.  If at any time during the Executive’semployment the Executive is unable to perform fully the material andsubstantial duties of the Executive’s regular job position hereunder by reasonof illness, accident, or other disability (as confirmed by competent medicalevidence by a physician selected by the Executive Committee of the Board), theExecutive shall be entitled to receive periodic payments of Salary, Bonus andany and all benefits to which he/she would otherwise be entitled by reason ofhis/her employment for a period of ninety (90) days. If the Executive isprevented by reason of any illness, accident or other disability fromperforming the material and substantial duties of his/her regular job positionfor a period of 180 days, whether or not consecutive, in any 12 month periodwhich, in the opinion of a physician selected by the Executive Committee of theBoard is likely to continue to the same degree, he/she will be considered to besuffering from a Disability (“Disability”). Notwithstanding the foregoingprovision (i) the amounts payable to the Executive pursuant to this Section1 shall be reduced by any amounts received by the Executive with respect toany such incapacity pursuant to any insurance policy, plan, or other employeebenefit provided to the Executive by the Company; and (ii) in no event will theterms of this Agreement supersede any health or disability benefit to whichExecutive is entitled under applicable law.

# 2.             Change in Control.  In the event of a “change in control” of theCompany (“change in control” of the Company shall mean a change in theownership of fifty percent (50%) or more of the outstanding stock of theCompany in a single transaction or series of transactions effected by a thirdparty or third parties acting in concert, or a change of fifty percent (50%) ormore of the members of the Board in a single transaction or series oftransactions effected by any third party or third parties acting in concert,other than pursuant to nomination of a new slate of directors where there hasbeen no material change in beneficial 

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# ownership of the Companywithin 365 days preceding such nomination or a sale of substantially all of theCompany’s assets), all of the Executive’s options will immediately vest andbecome exercisable. In the event of a change in control as (described above)and if the Executive is: (i) involuntarily terminated within 365 days followingthe change in control; or (ii) voluntarily terminates his/her employment withthe Company within 365 days following such change of control, following either:(a) any reduction in Executive’s responsibilities or authority with respect tothe Business; (b) a reduction in Executive’s compensation package, includingthen current salary, in effect immediately prior to the change in control; or(c) the Company’s principal place of business is relocated more than 30 milesfurther from the Company’s current headquarters location as of the date of thisAgreement; then the Executive will be entitled to (A) 12 months then currentSalary as a change in control allowance, to be paid in a single payment withinthirty (30) days of such termination of Executive’s employment, plus (B) anamount equal to one-twelfth of the maximum amount of the Executive’s thencurrent annual bonus determined without regard to the achievement ofperformance targets for each month of the current plan year during which theExecutive was employed plus an additional 12 months, to be paid in a singlepayment within thirty (30) days of the termination of Executive’s employment,and (C) a continuation of the welfare benefits of health care, life andaccidental death and dismemberment, and disability insurance coverage(collectively, “Supplemental Benefits”) for 12 months after the effective dateof termination. These benefits shall be provided at the same cost to theExecutive (if any), and at the same coverage level, as in effect as of theExecutive’s effective date of termination. However, in the event the premiumcost and/or level of coverage shall change for all management employees withrespect to Supplemental Benefits, the cost and/or coverage level, likewise,shall change for the Executive in a corresponding manner. The continuation ofSupplemental Benefits shall be discontinued in the event Executive hasavailable substantially similar welfare benefits at a comparable cost from asubsequent employer. For purposes of this Agreement, no change in ownership ordirectors as a result of the merger of the Company with Cedara Software Corp.shall be considered when determining whether a change in control has occurred.

In addition, upon a “changeof control” as defined above, the Company will deposit Fifty Thousand Dollars($50,000) into an interest-bearing escrow account (the “Escrow”) to be held bya third party mutually acceptable to the Executive and the Company. The cost ofsuch escrow shall be paid by the Company. The purpose of the escrow shall be toprovide Executive a “stay bonus” to help assure a smooth transition if theacquiror in a change of control transaction requests that Executive continuehis/her employment with the Company in an executive or managerial capacitysuitable for Executive’s background, although not necessarily the same positionpreviously occupied by Executive. The compensation, bonus and benefits to bepaid to Executive during such period following the change in control must be atleast the same as paid or provided prior to closing except for minor changes inSupplemental Benefits. Executive’s services pursuant to this paragraph shall beperformed within 30 miles from the Company’s current headquarters location asof the date of this Agreement, except for travel consistent with Executive’sposition prior to the change in control. The total amount in such Escrow,including interest thereon, will be paid to the Executive twelve monthsfollowing the change in control if Executive has substantially performed theservices requested to be performed by the acquiror following such change ofcontrol transaction. If the acquiror does not request Executive’s service afterthe change in control, no amount shall be paid to 

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Executive from the Escrow. If the acquiror requestsless than a full year of service, a pro rata amount of the Escrow shall be paidto Executive based upon the number of months or partial months worked dividedby twelve. At the end of the stay bonus performance period Executive shall havea period of thirty days following the termination of such services or 365 daysfollowing the change of control, whichever is later, to terminate his/herservices with the Company and be entitled to receive the change of controlpayments in addition to the stay bonus described in this paragraph.

# 3.             Termination. This Agreement may be terminated by the Company or the Board orappropriate committee thereof at any time for the following reasons:

## (a)           For Cause, by written notice to theExecutive. “Cause” shall mean termination for gross negligence, commission of afelony or material violation of any Company policies;

## (b)           In the event of the death of theExecutive;

## (c)           The Executive’s resignation orretirement from employment with the Company (this clause shall not be construedas an agreement to employ the Executive for a defined term), upon thirty (30)days advance written notice to the Company;

## (d)           In the event of the Disability of theExecutive as defined in Section 1 of this Agreement, subject to theCompany discharging its duty to accommodate under applicable law, by writtennotice to the Executive and by providing to the Executive the severanceentitlements set out in Section 4;

## (e)           By the Executive for “Good Reason,”defined as including only constructive termination, a material reduction inbase salary or a material reduction in responsibility, by written notice fromthe Executive; and

## (f)            Without Cause for any reason otherthan as set forth above in Subsection 3 (a), (b), (c), (d) or (e), byproviding to the Executive the severance entitlements set out in Section 4.

# 4.             Severance.  In the event that the Executive is terminatedpursuant to Subsection 3 (d), (e) or (f), and the Executive has executeda Company release substantially in the form of the attached Exhibit A, then theCompany shall pay the Executive, as a severance allowance, (A) an amount equalto 12 months of the Executive’s then current Salary plus (B) an amount equal toone-twelfth of the Executive’s then current calculated bonus, determined bytaking the maximum amount of bonus in effect for the then current year timesthe Executive’s individual goal performance score from the previous year, foreach month of the current plan year during which the Executive was employedplus an additional 12 months and (C) a continuation of the welfare benefits ofhealth care, life and accidental death and dismemberment, and disabilityinsurance coverage (collectively, “Supplemental Benefits”) for 12 months afterthe effective date of termination. These benefits shall be provided at the samecost to the Executive (if any), and at the same coverage level, as in effect asof the Executive’s Effective Date of Termination. However, in the event thepremium cost and/or level of coverage shall change for all management employeeswith respect to Supplemental Benefits, the cost and/or coverage level,likewise, shall change for the Executive in a corresponding manner. The amountof the severance allowance provided for in subsections (A) and (B) of this Section4 shall be paid in equal 

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# installments over theseverance period. Notwithstanding anything to the contrary contained herein, inthe event the Executive elects to receive (pursuant to the operation of Section2) 12 months of his/her then current salary following a change in controlevent and Executive’s voluntary or involuntary termination, then Executiveshall not be entitled to any payment of severance pursuant to this Section 4.In the event a change in control occurs and the Executive is not entitled to 12months of his/her then current salary pursuant to Section 2, then theExecutive shall continue to be entitled to receive severance payments per this Section4.

# 5.             Surrender of Properties.  Upon termination of the Executive’semployment with the Company, regardless of the cause therefor, the Executiveshall promptly surrender to the Company all property provided him/her by theCompany for use in relation to his/her employment, and, in addition, theExecutive shall surrender to the Company any and all confidential salesmaterials, lists of customers and prospective customers, price lists, files,patent applications, records, models, or other materials and information of orpertaining to the Company or its customers or prospective customers or theproducts, Business, and operations of the Company in his/her possession.

# 6.             Inventions and Secrecy.  Except as otherwise provided in this Section6 the Executive:

## (a)           shall hold in afiduciary capacity for the benefit of the Company all secret or confidentialinformation, knowledge, or data of the Company or its Business or productionoperations obtained by the Executive during his/her employment by the Company,which shall not be generally known to the public or recognized as standardpractice (whether or not developed by the Executive) and shall not, duringhis/her employment by the Company and after the termination of such employmentfor any reason, communicate or divulge any such information, knowledge or datato any person, firm or corporation other than the Company or persons, firms orcorporations designated by the Company;

## (b)           shall promptlydisclose to the Company all inventions, ideas, devices, and processes made orconceived by him/her alone or jointly with others, from the time of enteringthe Company’s employ until such employment is terminated, relevant or pertinentin any way, whether directly or indirectly, to the Company’s Business orproduction operations or resulting from or suggested by any work which he/shemay have done for the Company or at its request;

## (c)           shall, at all timesduring his/her employment with the Company, assist the Company (entirely at theCompany’s expense) to obtain and develop for the Company’s benefit patents onsuch inventions, ideas, devices and processes, whether or not patented; and

## (d)           shall do all suchacts and execute, acknowledge and deliver all such instruments as may benecessary or desirable in the opinion of the Company to vest in the Company theentire interest in such inventions, ideas, devices, and processes referred toabove.

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The foregoing to thecontrary notwithstanding, the Executive shall not be required to assign oroffer to assign to the Company any of the Executive’s rights in any inventionfor which no equipment, supplies, facility, or trade secret information of theCompany was used and which was developed entirely on the Executive’s own time,unless: (A) the invention related to (i) the Business of the Company; or (ii)the Company’s actual or demonstrably anticipated (with the realistic prospectof occurring) research or development; or (B) the invention results from anywork performed by the Executive for the Company. The Executive acknowledgeshis/her prior receipt of written notification of the limitation set forth inthe preceding sentence on the Executive’s obligation to assign or offer toassign to the Company the Executive’s rights in inventions.

# 7.             Confidentiality of Information: Duty ofNon-Disclosure.

## (a)           The Executiveacknowledges and agrees that his/her employment by the Company under thisAgreement necessarily involves his/her understanding of and access to certaintrade secrets and confidential information pertaining to the Business of theCompany. Accordingly, the Executive agrees that after the date of thisAgreement at all times he/she will not, directly or indirectly, without theexpress consent of the Company, disclose to or use for the benefit of anyperson, corporation or other entity, or for himself/herself any and all files,trade secrets or other confidential information concerning the internal affairsof the Company, including, but not limited to, information pertaining to itscustomers, prospective customers, services, products, earnings, finances,operations, methods or other activities, provided, however, that the foregoingshall not apply to information which is of public record or is generally known,disclosed or available to the general public or the industry generally, orknown by Executive prior to his/her employment with the Company. Further, theExecutive agrees that he/she shall not, directly or indirectly, remove orretain, without the express prior written consent of the Company, and upontermination of this Agreement for any reason shall return to the Company, anyconfidential figures, calculations, letters, papers, records, computer disks,computer print-outs, lists, documents, instruments, drawings, designs,programs, brochures, sales literature, or any copies thereof, or anyinformation or instruments derived therefrom, or any other similar informationof any type or description, however such information might be obtained orrecorded, arising out of or in any way relating to the Business of the Companyor obtained as a result of his/her employment by the Company. The Executiveacknowledges that all of the foregoing are proprietary information, and are theexclusive property of the Company. The covenants contained in this Section 7shall survive the termination of this Agreement.

## (b)           The Executive agreesand acknowledges that the Company does not have any adequate remedy at law forthe breach or threatened breach by the Executive of his/her covenant, andagrees that the Company shall be entitled to injunctive relief to bar theExecutive from such breach or threatened breach in addition to any otherremedies which may be available to the Company at law or in equity.

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# 8.             Covenant Not to Compete.

## (a)           During Executive’sEmployment.  During the Executive’semployment, the Executive shall not, without the. prior written consent of theCompany, which consent may be withheld at the sole and reasonable discretion ofthe Company, engage in any other business activity for gain, profit, or otherpecuniary advantage (excepting the investment of funds in such form or manneras will not require any services on the part of the Executive in the operationof the affairs of the companies in which such investments are made) or engagein or in any manner be connected or concerned, directly or indirectly, whetheras an officer, director, stockholder, partner, owner, employee, creditor, orotherwise, with the operation, management, or conduct of any business thatcompetes with the Business of the Company.

## (b)           Following Terminationof the Executive’s Employment. Within the 12 month period immediately following the end of theExecutive’s employment, regardless of the reason therefore, the Executive shallnot engage in the following, but only to the extent that these activitiescompete in a similar Business to the Company, without the prior written consentof the Company, which consent may be withheld at the sole discretion of theCompany: (A) engage in or in any manner be connected or concerned, directly orindirectly, whether as an officer, director, stockholder, partner, owner,employee, creditor, or otherwise with the operation, management, or conduct ofany business similar to the Business being conducted at the time of suchtermination within a 100-mile radius from the Company’s current headquarterslocation as of the date of this Agreement; (B) directly solicit, contact,interfere with, or divert any customer served by the Company for the Business,or any prospective customer identified by or on behalf of the Company, duringthe Executive’s employment with the Company; or (C) directly solicit anyemployee then employed by the Company or previously employed by the Companywithin the one year period preceding termination of the Executive’s employmentwith the Company to join the Executive, whether as a partner, agent, employeeor otherwise, in any enterprise engaged in a business similar to the Businessof the Company being conducted at the time of such termination.

## (c)           Acknowledgment.  The Executive acknowledges that the restrictionsset forth in Section 8 are reasonable in scope and essential to thepreservation of the Business of the Company and proprietary properties and thatthe enforcement thereof will not in any manner preclude the Executive, in theevent of the Executive’s termination of employment with the Company, frombecoming gainfully employed in such manner and to such extent as to provide astandard of living for himself/herself, the members of his/her family, andthose dependent upon him of at least the sort and fashion to which he/she andthey have become accustomed and may expect.

## (d)           Severability.  The covenants of the Executive contained in Section8 of this Agreement shall each be construed as an agreement independent ofany other provision in this Agreement, and the existence of any claim or causeof action of the Executive against the Company, whether predicated on thisAgreement or otherwise, shall not constitute a defense to the enforcement bythe Company of such covenants. Both parties hereby expressly agree and contractthat it is not the intention of either party 

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## to violate anypublic policy, or statutory or common law, and that if any sentence, paragraph,clause, or combination of the same of this Agreement is in violation of thelaw, such sentence, paragraph, clause or combination of the same shall be void,and the remainder of such paragraph and this Agreement shall remain binding onthe parties to make the covenants of this Agreement binding only to the extentthat it may be lawfully done. In the event that any part of any covenant ofthis Agreement is determined by a court of law to be overly broad therebymaking the covenant unenforceable, the parties hereto agree, and it is theirdesire, that such court shall substitute a judicially enforceable limitation inits place, and that as so modified the covenant shall be binding upon theparties as if originally set forth herein.

# 9.             General Provisions.

## (a)           Goodwill.  The Company has invested substantial time andmoney in the development of its products, services, territories, advertisingand marketing thereof, soliciting clients and creating goodwill. By acceptingemployment with the Company, the Executive acknowledges that the customers arethe customers of the Company, and that any goodwill created by the Executivebelongs to and shall inure to the benefit of the Company.

## (b)           Notices.  Any notice required or permitted hereundershall be made in writing (i) either by actual delivery of the notice into thehands of the party thereunder entitled, or (ii) by depositing the notice with anationally recognized overnight delivery service, all shipping costs prepaidand addressed to the party to whom the notice is to be given at the party’srespective address set forth below, or such other address as the parties mayfrom time to time designate by written notice as herein provided.

| *As addressed to the Company:*                                                                               | *With a copy to:*                             |
|--------------------------------------------------------------------------------------------------------------|-----------------------------------------------|
|                                                                                                         |                                          |
| Merge Technologies  Incorporated                                                                             | Michael Best & Friedrich LLP              |
| 6737 W. Washington  Street                                                                                   | 100 East Wisconsin Avenue                |
| Milwaukee, Wisconsin  53214-5650                                                                             | Suite 3300                                    |
| Attention:  Chief Executive Officer                                                                     | Milwaukee, Wisconsin 53202                    |
|                                                                                                         | Attention:   Geoffrey R. Morgan, Esquire |
|                                                                                                         |                                          |
| *As  addressed to the Executive:*                                                                            |                                          |
| Steve Oreskovich                                                                                             |                                          |
| 1302 S. 91st Street                                                                                          |                                          |
| West Allis, WI  53214                                                                                        |                                          |
|                                                                                                         |                                          |
| The notice shall be  deemed to be received on the date of its actual receipt by the party entitled  thereto. |

##  

## (c)           Amendment andWaiver.  No amendment or modificationof this Agreement shall be valid or binding upon the Company unless made inwriting and signed by an officer of the Company duly authorized by the Board orupon the Executive 

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## unless made in writing and signed by him. The waiver by the Company ofthe breach of any provision of this Agreement by the Executive shall notoperate or be construed as a waiver of any subsequent breach by him.

## (d)           Entire Agreement.  This Agreement constitutes the entireAgreement between the parties as an executive of the Company, and there are norepresentations, warranties, agreements or commitments between the partieshereto with respect to his employment except as set forth herein, as set forthin Schedule G of the Merger Agreement between Cedara Software Corp. and theCompany. No presumption shall be made in favor or against either party basedupon who has served as draftsman of this Agreement.

## (e)           Governing Law.  This Agreement shall be governed by andconstrued in accordance with the internal laws (and not the law of conflicts)of the State of Wisconsin.

## (f)            Severability.  If any provision of this Agreement shall, forany reason, be held unenforceable, such provision shall be severed from thisAgreement unless, as a result of such severance, the Agreement fails to reflectthe basic intent of the parties. If the Agreement continues to reflect thebasic intent of the parties, then the invalidity of such specific provisionshall not affect the enforceability of any other provision herein, and theremaining provisions shall remain in full force and effect.

## (g)           Assignment.  The Executive may not under any circumstancesdelegate any of his/her rights and obligations hereunder without firstobtaining the prior written consent of the Company. This Agreement and all ofthe Company’s rights and obligations hereunder may be assigned or transferredby it, in whole or in part, to be binding upon and inure to the benefit of anysubsidiary or successor of the Company, provided either the successor has a networth greater than the Company at the time of assignment or the Company remainsprimarily liable with respect to the obligations so assigned.

## (h)           Costs of Enforcement, Litigation.  In the event of any suit or proceedingseeking to enforce the terms, covenants, or conditions of this Agreement, theprevailing party shall, in addition to all other remedies and relief that maybe available under this Agreement or applicable law, recover his/her or itsreasonable attorneys’ fees and costs as shall be determined and awarded by thecourt. Any controversy or dispute with respect to the terms of Section 5, 6,7 or 8 of this Agreement will survive termination of this Agreement andshall be litigated in the state of federal courts of competent jurisdictionsituated in Milwaukee, Wisconsin, to which jurisdiction and venue all partiesconsent.

## (i)            Mitigation.  The Executive shall not be obligated to seekother employment in mitigation of the amounts payable under this Agreement, andthe obtaining of any such other employment shall in no event effect anyreduction of the Company’s obligations to make payments hereunder.Notwithstanding the foregoing, if Executive receives the payments described in Section9 by terminating his/her employment following a change in control andExecutive subsequently becomes re-employed by the Company or by the party orparties effecting the change in control, the 

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## amounts earnedon re-employment (up to a period of one year’s compensation) shall be repaid tothe Company.

# 10.           Executive Acknowledgement.  The Executive acknowledges that:

## (a)           the Executive has had sufficient timeto review this Key Officer Agreement thoroughly;

## (b)           the Executive has read andunderstands the terms of this Key Officer Agreement and the obligationshereunder;

## (c)           the Executive has received the goodand adequate consideration for entering into this Key Officer Agreement; and

## (d)           the Executive has been given anopportunity to obtain independent legal advice concerning the interpretationand effect of this Key Officer Agreement.

IN WITNESS WHEREOF, this Agreement is entered into asof the day and year first above written.
|   | **COMPANY:**                         |
|--------|--------------------------------------|
|   | ** **                           |
|   | **MERGE TECHNOLOGIES  INCORPORATED** |
|   | ** **                           |
|   | ** **                           |
|   | By:                                  | /s/ Richard A. Linden |
|   |                                 | Richard A. Linden |
|   |                                 | President and Chief  Executive Officer |
|   |                                 |
|   |                                 |
|   | **EXECUTIVE:**                       |
|   | ** **                           |
|   | By:                                  | /s/ Steve Oreskovich |
|   |                                 | Steve Oreskovich |
|        |                                      |  |  |

 

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**RELEASE**

**EXHIBIT A**

I, _______________ (Employee), in consideration of thepayments made by Merge Technologies Incorporated (“Company”) to me pursuant tothe severance section in the Key Officer Agreement, dated_____________________, the adequacy of which is hereby acknowledged, do herebyrelease and discharge the Company and all of its directors, officers, owners,agents, employees, attorneys, insurers, affiliates, subsidiaries, relatedcorporations, predecessors, successors, heirs and assigns, (collectively “ReleasedPersons and Entities”) from any and all sums of money, attorneys fees,accounts, motions, causes of action, claims, demands or liabilities of any ‘kindor character whatsoever, whether known or unknown, which I either have had ornow have against such Released Persons and Entities, or any of them, for or relatedin any way to anything occurring from the beginning of time to the date ofexecution of this Release.

Without limiting the generality of the foregoing, thisRelease applies to any and all claims, causes of action, demands orliabilities, which I have had or now have:

(a)                                  Forany and all tort, contract, common law, statutory or other claims.

(b)                                 Forany and all Claims under or pursuant to the Americans With Disabilities Act,Title VII of the Civil Rights Act of 1964, as amended, the Civil Rights Act of1991, the Equal Pay Act, the Fair Labor Standards Act, the Employee RetirementIncome Security Act of 1974, the Age Discrimination in Employment law, theOlder Workers Benefit Protection Act, the Employee Retirement Income SecurityAct “ERISA” (except for vested benefits which are not affected by thisagreement) the National Labor Relations Act, the Federal Family Medical LeaveActs, any and all Claims under federal, state or local wage payment laws or anyother federal, state or local law, statute, ordinance, rule, regulation orexecutive order, and/or any Claims to attorneys’ fees or costs thereunder. Theforegoing does not supersede the employee’s rights to any workers’ compensationclaims and any pension or unemployment compensation claims.

(c)                                  Forwrongful termination of employment, including violations of public policy.

(d)                                 Forbreach of contract, whether express or implied.

(e)                                  Forlibel, slander, defamation, damage to reputation, intentional or negligentinfliction of emotional distress or other tortious conduct.

In addition to the above, I warrant that I haveneither filed nor joined in any complaint, charge, claim, lawsuit or otherproceeding of any kind against Company or any of the other Released Parties andEntities identified above. I promise never to file, join in or pursue anycomplaint, charge, claim, lawsuit or other proceeding asserting any claimsreleased above. 

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The Company reserves theright to immediately terminate any payments due under this Agreement in theevent of a breach of this Release, and shall have the right to seek all legalremedies, including injunctive relief, in any court of competent jurisdictionbarring Employee from further breaches of this Release.

I have read this Release, have had sufficient time toconsider its contents and agree to its terms and conditions of my own freewill. I also understand that this Release includes a final general release andthat I can make no further claims against the Released Persons and Entities inconnection with my employment or the termination thereof.
| **EMPLOYEE:**       |       |
|---------------------|------------|
| ** **          |       |
| ** **          | ** ** |   |
| Name (Please Print) | Signature  |
|                |       |
|                |       |   |
| Date                |       |

 

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