Originator: HSCA
Document date: 1977-01-01 00:00:00
Document type: PRINTED FORM

# DOCID-32239451

## Page 1

Date: 08/20/93

Page: 1

JFK ASSASSINATION SYSTEM

IDENTIFICATION FORM

AGENCY INFORMATION

AGENCY : HSCA

RECORD NUMBER: 180-10060-10443

RECORDS SERIES :

STAFF PAYROLL RECORDS

AGENCY FILE NUMBER :

DOCUMENT INFORMATION

ORIGINATOR : HSCA

FROM :

то :

TITLE :

Released under the John F

Kennedy Assassination

Records Colection Act ol

1992 (44 USC 2107 Note).

Case#:NW/ 66000 Date:

11-04-2021

DATE: 01/01/77

PAGES: 42

SUBJECTS :

HSCA, ADMINISTRATION

HOLT, LAURA

DOCUMENT TYPE : PRINTED FORM

CLASSIFICATION : U

RESTRICTIONS : 3

CURRENT STATUS : P

DATE OF LAST REVIEW : 06/04/93

OPENING CRITERIA :

COMMENTS :

Box

2.

[R] - ITEM IS RESTRICTED

NW 66000

Docld:32239451 Page 1

---

## Page 2

MEMORANDUM

OF CALL

TO:

YOU WERE CALLED BY-

• YOU WERE VISITED BY-

OF (Organization)

PLEASE CALL -

WILL CALL AGAIN

PHONE NO.

CODE/EXT.

• IS WAITING TO SEE YOU

• WISHES AN APPOINTMENT

RETURNED YOUR CALL

MESSAGE

Jaura Holts 19717

carmings

18,997.23

RECEIVED BY

DATE

STANDARD FORM 63

REVISED AUGUST 1967

GSA FPMR (41 CFR) 101-11.6

OPO: 1089-018-16-80341-1 832-389

TIME

63-108

NW 66000

Docld:32239451 Page 2

---

## Page 3

HoRT.

A.M

Naine of Employee

Posilion Nümber

Address

Address

Fronic Plumber

Position Title

DATE OF APPOINTMENT

1-1-97

PRIOR FEDERAL SERVICE

Level

Step

DAY OF MONTH

13756

3TOT TETIET TETIET 14 T15 17 TIS TOT 20

21

22

23 | 24

OFFICE OF THE CLERK

U.S. HOUSE OF REPRESENTATIVES

PERSONAL LEAVE RECORD

1997

YEAR

ANNUAL LEAVE

CATEGORY

1.0

1.5

2.0

D

ACCRUED

THIS MONTH

25

26

27.

28

20

30

31

Annual.

Leave

Sick

LeavE

/

/

/.

AVAILABLE

THIS MONTH

Annual

Leave

Sick

Leave

BALANCE BROUGHT

FORWARD

FROM

PRECEDING

YEAR

Annual

Leäve

Sick

Leave

USED

THIS MONTH

Annual

Leave

Sick

Leave

Month

Jan.

Feb.

Mar.

Apr.

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

= 0.5 day annual leave

= 1.0 day annual leave

= 0.5 day sick leave

or

= 1.0 day sick leave

or

0.5 day administrative leave

= 1.0 day administrative leave

U

or

= 0.5 day unauthorized absence

= 1.0 day unauthorized absence

= 0.5 day leave without pay

= 1.0 day leave without pay

NWV 66000

Docld:32239451 Page 3

BALANCE

AT

OF

CLOSE

MONTH

Annual

Leave

3

5

Sick

Leave

/.

2

4

5

9

EMPLOYEE

INITIALS

9

9

9

Terminated

11).

7

CERTIFIED CORRECT:

Employce's Signature

Dote

(if employee refuses to sign, state reason below.)

Chief's Signature

Approved: -

Date

Clerk of the House

Date

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

---

## Page 4

PAYROLL AUTHORIZATION FORM

(Please Use Typewriter

or Ballpoint Pen)

U.S. HOUSE OF REPRESENTATIVES

Washington, D.C. 20515

(Any erasures, corrections, or changes

on this form must be initialed by the

authorizing official.)

To the Clerk of the House of Representatives:

I hereby authorize the following payroll action:

•Employee Name (First-Middle-Last)

Effective Date

Laura

Hott

Employee Social Security Number

Moverber 4, 1977

Type of Action

559-23-6038

Employing Office or Committee/Subcommittee

Assessinations

• Appointment

• Salary Adjustment

• Title Change

2L. Termination (At close of business on effective date)

• Leave without pay (Beginning with effective date above änd ending

close of business_

(If type of action is an Appointment, Salary Adjustment, or Title Change, complete appropriate information below.)

Position Title

Specify Date

Gross Annual Salary*

::* If employee is d 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.)

1.0

Standing Committee: Staff— Clerical or • Professional.

2. 58 Special (Investigative staff of Standing Committee) or Select Committee: Authority-H. Res. $65

5. _of 958tCongress.

3. • Joint Committee.

(If Employee of an Officer of the House, complete item below.)

Position Number_

If applicable, Level -

Step

I certity that this authorization is not in violation

of 5 U.S.C. 3110(b), prohibiting the employment of

relatives.

Date_

November &

78

19

(Signature of Authorizing Official)

Louis Stokes

If appropriate, signature of Subcommittee. Chairman or. Ranking Minority Member)

(Type or print name of Authorizing Official)

Chairman

(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, must

be approved by the Committee on House Administration.

APPROVED:

Office of Finance use only:

Office Code..

Monthly Annuity $

Chairman, Committee on House Administration

ID --

Benefits -

Payroll -

00 as of

Copy for: Initiating Office or Committee

(Revised: August! 1977)

NW 66000

Docld:32239451 Page 4

---

## Page 5

MEMORANDUM

TO: Tom Howarth, Budget Officer

FROM: G. Robert Blakey, Chief Counsel and Director 6710-4107)

SUBJECT: Laura Holt

DATE: October 4, 1977

Miss Holt will be on administrative leave

effective today. Her administrative leave will continue

through November 4th. At that time, her position

with the

Committee will terminate.

NW 66000

Docld:32239451 Page 5

---

## Page 6

MEMORANDUM

TO: Tom Howarth, Budget Officer

FROM: G. Roberg Blakey, Chief Counsel and Director

SUBJECT: Laura Holt

DATE: October 4, 1977

Miss Holt will be on administrative leave

effective today. Her administrative leave will continue

through November 4th. At that time, her position with the

Committee will terminate.

NW 66000

Docld:32239451 Page 6

---

## Page 7

PAYROLL AUTHORIZATION FORM

Please Use Typewriter

or Ballpoint Pen)

U.S. HOUSE OF REPRESENTATIVES

Washington, D:C. 20515

(Any erasures, corrections, or changes

on this form must be initialed by the

authorizing official.)

To the Clerk of the House of Representatives:

I hereby authorize the following payroll actioner

Employee Name (First-Middle-Last)

Laura

N. Holt

Employee Social Security Number

559 28 5038

Effective Date

9/1/77

Type of Action

Employing Office or Committee

• Appointment

Ẻ Salary Adjustment

I Termination (At close of business on effective date)

Assassinations

(If type of action is an Appointment:or Salary Adjustment, complete:the föllowing information.)

Position Title

Staff Counsel

Gross Annual Salary

$24,000

(If Committee Employee, complete appropriate item below.)

1. L Standing Committee: Staff - Clerical or a Professional.

2. [ Special or Select Committee: Authority -H. Res. 165

tof 35 th

*_Congress.

3. E: Joint Committee.

(If Employee of an Officer of the House, complete item belöw.)

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_-

Septerber 15

., 192?

(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.:

APPROVED

Chairman, Committee on House Administration

Office of Finance use only:

Office Code.

Monthly Annuity $

.00

Copy for Initiating Office or Committee

NW 66000

Docld:32239451 Page 7

---

## Page 8

PAYROLL AUTHORIZATION FORM

(Please Use Typewriter

or Ballpoint Pen).

U.S. HOUSE OF REPRESENTATIVES

Washington, D.C: 20515

(Any erasures, corrections, or changes

on this form must be initialed by the

authorizing official.)

To the Clerk of the House of Representatives:

I hereby authorize the following payroll action:

Employee Name (First-Middle-Last)

Effective Date •

Laura

Mav Holt

Employee Social Security Number

8/1/77

Type of Action

559-20-5038

Employing Office or Committee

Assassinations

_ 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

Staff Counsel

24,000

(If Committee. Employee, complete appropriate item below.)

1. E Standing Committee: Staff.-E] Clerical or :Professional.

2. 7. Special or Select Committee: Authority-H. Res.65

-of 25th

-Congress.

3.

Joint Committee.

(If Employee of an Officer of the House, complete item.below.):

nance

didn't process

Why"

Position Number_.

If applicable; Level_2-22:

Step_-

I certify that this authorization is not. in violation of U.S,Cn 3110(b), prohibiting prohibiting the employment-of

relatives.

Date-

August 2

19.

(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, müst

be approved by the Committee on House Administration.

APPROVED:

Chairman, Committee or House Administration:

Office of Finance use only::

Office Code.

Monthly Annuity S

:00

Copy for Initiating Office or Committee

NW 66000

Docld:32239451 Page 8

---

## Page 9

PAYROLL AUTHORIZATION FORM

•(Please Use Typewriter

•or Ballpoint Pen):

U.S. HOUSE OF REPRESENTATIVES

Washington, D.C. 20515

(Any erasures, corrections, or changes

on this form must be initialed by the

authorizing official.)

To the Clerk of the House of Representatives:

I hereby authorize the following payroll action:

Laura Has Kolt

559

28 5038

Employee Name (First-Middle-Last)

Employee Social Security Number

Effective Date

7/5/77

Type of Action

Employing Office or Committee

[ Appointment.

E Salary Adjustment

• Termination (At close of business on éffective date)

Assassinations

(If type of action is an Appointment or Salary Adjustment; complete the following information.)

Position Title

Gross Annual Salary

Staff Counsel

$23,400

(If. Committee Employee, complete appropriate item below.)

1. E Standing Committee: Staff - Clerical or ] Professional.

2807 Special or Select Committee: Authority-H. Res. 452

95 til Congress.

-all

3. 1

Joint Committee.

(If Employee of an Officer of the House, complete item below.)

Position Number.

If applicable, Level_

Finance

alicea

$27,692.30

I certity: that this authorization is not, in violation of 5 U.S.C. 3110(b), prohibiting the employment of

relatives.

Date -

July 6

(Signature of Authorizing Official)

Louis Stokes

(Type or print name of Authorizing Official),

. Chairhan

(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.

APPROVED:.

Chairman, Committee on House Administration'

Office of Finance use only:

Office Code

Monthly Annuity $

.00

Copy for Initiating Office or Committee

NW 66000

Docld:32239451 Page 9

---

## Page 10

PAYROLL AUTHORIZATION FORM

(Please-Use Typewriter

or Ballpoint Pen)

U.S. HOUSE OF REPRESENTATIVES

Washington; D.C. 20515

(Any erasures, corrections, or changes

on this form must be initialed by the

authorizing official.)

To the Clerk of the House of Representatives:

I hereby authorize the following payroll action:

Employee Name (First-Middle-Last)

Laura

Mas Molt

Employee Social Security Number

559 28 5038

Employing Office or Committee

Assassinations

Effective Date

6/30/77

Type of Action

'I 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

Staff Counsel

(If Committee Employee, complete appropriate item-below.)

1: L Standing Committee: Staff-D Clerical or • Professional.

2. I Special or Select Committee: Authority - H. Res.

-465

- 3.

_ Joint Committee.

of 3Sch Congress.

(If Employee of an Officer of the House, complete item below.)

Position Number_

If applicable, Level

Step-

30

offer.

I. certify that this authorization is not in violation. of 5 U.S.C. 3110(b), prohibiting the employment of

relatives.

Date_

June

30

(Signature of Authorizing Officiall

Louis Stokes

(Type or print name of Authorizing Official)

Chaiman

(Title - If Membér, 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.

APPROVED:

Chairman, Committee on House Administration.

Office of Finance use only:

Office Code

Monthly Annuity S

poin

.00

Copy for Initiating Office or Committee

NW 66000

Docld:32239451 Page 10

---

## Page 11

PAYROLL AUTHORIZATION FORM

(Please Use Typewriter

or Ballpoint Pen)

U.S: HOUSE OF REPRESENTATIVES

Washington, D.C. 20515

(Any erasures,.corrections, or changes

ön this form must be initialed by the

authorizing official.)

To the Clerk of the House of Representatives:

I hereby authorize the following payroll action:

Laura

Employee Name (First-Middle-Last)

Mac Holt

Effective Date

5/1/77

Employee Social Security Number

Type of Action

559 28 5038

Assassinations

Employing Office or Committee

_ 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

$20,000

(It: Committee Employee, complete.appropriate item below.)

1.0

Standing Committee: Staff - Clerical or ] Professional:

2. 0

Special or Select Committee: Authority-H. Res.

465

of95 th

Congress:

3.

Joint Committee.

(If Employee of an Officer of the House, complete item below.)

Position Number_

If applicable, Level.

Step_:

certify: that. this authorization. is not in violation of 5 U.S.C. 3110(b), prohibiting the employment of

relatives.

Date -

Hey 10

(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. "

APPROVED:.

Chairman, Committee on House Administration

Office of Finance use only:

Office Code._

Monthly Annuity S_

00

Copy for Initiating Office or Committee

NW 66000

Docld:32239451 Page 11

---

## Page 12

PAYROLL AUTHORIZATION FORM

(Please Use Typewriter

or Ballpoint Pen)

U.S. HOUSE OF REPRESENTATIVES

Washington, D.C. 20515'

(Any erasures, corrections, or changes

on this form must be initialed by the

authorizing official.)

To the Clerk of the House of Representatives:

I hereby authorize the following payroll action:

Employee Name (First-Middle-Last)

Effective Date

Laura Mae Holt

4/1/77

Employee Social Security Number

Type of Action

559 28 5038

Assassinations

Employing Office or Committee

[ Appointment

[Sclary 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

$42,400

(If Committee Employee, complete appropriate item below.)

1. I 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)

Chairnan

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..

APPROVED:

Chairman, Committee on House Administration

Office of Finance use only:

Office Code._

Monthly Annuity $

•00

Copy for Initiating Office or Committee

NW 66000

Docld:32239451 Page 12

---

## Page 13

PAYROLL AUTHORIZATION FORM

(Please Use Typewriter

or Ballpoint Pen)::

U:S. HOUSE OF REPRESENTATIVES

Washington, D.C. 20515

(Any erasures, corrections, or changes:

on this form must be initialed by the

authorizing official.)

To the Clerk of the House of Representatives:

I hereby authorize the following payroll action:

Employee Name (First-Middle-Last)

Effective Date

Laura Mae Holt

2-1-77

Employee Social Security Number

Type of Action

559-28-5038

• Appointment

Salary Adjustment

Employing Office or Committee

Select Committee on Assassinations

L 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

$12,300.

(If Committee Employee, complete appropriate item below.)

1: E Standing Committee: Staff - Clerical or [ Professional:

2. X. Special or Select Committee: Authority-H: Res..

_of_95 Congress..

3.

Joint Committee.

(If Employee of an Officer of the House; complete item below.)a

Position Number_.

If applicable, Level_.

Step_

i certify: that this authorization is:not in violation of: 5 U.S:C. 3110(b), prohibiting the employmen† öf:~"

relatives.

2-28-77

Date. -

19.

(Signature of Authorizing Official):

Hensy 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.

APPROVED:

w. Chairman, Committee on House Administration

Office of Finance use only:.

Office Code

Monthly Annuity $

.00

Copy for Initiating Office or Committee

NW 66000

Docld:32239451 Page 13

---

## Page 14

PAYROLL AUTHORIZATION FORM

-(Please Use Typewriter

or. Ballpoint Pen)

U.S. HOUSE OF REPRESENTATIVES

Washington, D.C: 20515

(Any erasures, corrections; or changes

on this form must be initialed by the

authorizing official.)

To the Clerk of the House of Representatives:

I'hereby authorize the following payroll action:

Employee Name (First-Middle-Last)

Effective Date

Laura

Nae Holt

1/3/77

Employee Social Security Number

Type of Action

599 28 5033

Employing Office or Committee

Select Committee on Assassinations

• 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

$73,0000

(If Committee Employee, complete appropriate item below.)

1: [ Standing Committee: Staff - Clerical.or • Professional.

. El Special or Select Committee: Authority-H. Res.!1

95th

of2sth

_Congress.

"3.1

J. 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 -Ü.S.C. 3110(b), prohibiting the employment of

relatives.

Date_=_

19.

77

(Signature of Authorizing Official)"

Henry B._ Conzalez.

(Type or print name of Authorizing Official)

Chairman

f Member, District and State)

All appointments. and salary adjustments for employees under the House Classification Act and for Committee em-

sployees, 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...

APPROVED:

Chairman, Committée on House Administration

Office of Finance use only:

Office Code.

Monthly Annuity $

.00

Copy for Initiating Office or Committee

NW 66000

Docld:32239451 Page 14

---

## Page 15

PAYROLL AUTHORIZATION FORM

(Please Use Typewriter

or Ballpoint Pen)

U.S. HOUSE OF REPRESENTATIVES

Washington, D.C: 20515

(Any erasures, corrections, or changes.

on this form must be initialed by the

authorizing official.)

To the Clerk of the House of Representatives:

I hereby authorize the following payroll action:

Employee Name (First-Middle-Last)

Effective Date

Laura Mae Holt

1/1/77

Employee Social Security Number

Type of Action

559 28 5038

Employing Office or Committee

Appointment

• Salary Adjustment

• Termination (At close of business on effective date)

Select Comnittee on Assassinations

•(If type of action is an Appointment or Salary Adjustment, complete the following information.)

Position Title

Gross Annual Salary

20,000

Staff Counsel

(If Committee Employee, completé appropriate item below.)

1. 0 Standing Committee: Staff- Clerical or • Professional.

2.1È Special Special or Select Committee: Authority-H. Res.1549

of 96th 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_

December 15

., 19%6

(Signature of Authorizing Official)

Thomas N. Downing, Chairman

(Type or print name of Authorizing Official)

, Select Committee on Assassinations

(Title

ember, Distric

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 Committeé on House Administration. •

APPROVED:

Chairman, Committee on House Administration

Office of Finance use only:

Office Code.

Monthly Annuity S_

.00

Copy for Initiating Office or Committee

NW 66000

Docld:32239451 Page 15

---

## Page 16

MEMORANDUM

TO:

All Staff Employees

FROM:

Budget Officer

DATE: January 3, 1977

RE:

Payroll Certification

Starting with the January, 1917 payroll, the certification

o 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.

SOn

daughter

brother

sister

uncle

aunt

first cousin

nephew

niece

husband

wife

father-in-law

mother-in-law

son-in-law

daughter-in-law

brother-in-law

sister-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

Lous no Halt

Signature of Employee

1-10-77

Date

NW 66000

Docld:32239451 Page 16

---

## Page 17

2054 Tavlor Run

Andrews AFE:

MC.

(501)

599-6549

20331

Ins dugeles, Califomia 90018

Telephones:

(213) 735-6348 - 6

(213) 734-49-41

EDUCATION

Soalt Hall School of Law, University of California, Burkeley

J. D. Degree - 1971

Los Angeles Pacific College - Los Angeles, Califorida

B. A. Degrce - 1963

Major: Sociolos

Minor: Political Science

MEMBERSIIP

Nember, Pennsylvania Bar Association

PROFESSIONAL EXPERIENCE

1971 - 1975

Rose Hemperley, Attorney at Law

117 D: 9th St., Los Angeles, Calif

LAW CLERK

Telephone: (213) 622-2075

Private firm practicing corporate, civil, domestic relations, criminal, and tax law.

1970 - 1971

White and Cruickshank

Altorneys at Law

Oakland, California

RESEARCH ASSISTANT (part-time)

Served as Research Assistant to Mr. Clinton White in this firm practicing criminal

las. Some exposure to trial work. Aiso, Assistant Editor/Research Assistant to

Professor Robert M. O'Neil at Boalt, during this period.

1967 - 1968

Central City Community Mental

Health Center, Los Angeles, Calif.

COORDINATOR of Youth Activities

Evaluated, and recominended workable solutions lo juvenile problems, on both an

individual and a group basis. Served as liaison and coordinated with outside agencies,

such as Police Dopartment and Sheriff's Olfice. Altended juvenile court hearings.

Participated in formulating and implementing progans.

1900-1967

Youth Training & Employment

Project, Los Ingeles, Calif.

INSTUCTOR in Basic Shills

Taught basie longlish, waiting and madlematies to school dreponte betucen 16 and

21. Counseled, deeded and graded, and provided assistanee on specific problems.

Mas sterossful in persueding a significant number of my students to return to

formad schooling

ceo: both acalemie and trade.

NW 66000

Docld:32239451 Page 17

---

## Page 18

LAURA MAE HOLT

lage Two

PROFESSIONAI, EXPERJENCE (Continued)

1965 - 196

Ventura School for Girls

Camarillo, California

GROUP SUPERVISOR

Evalu ted giris, composed behavior and progress reports. participated in group

counseling, set up and supervised programs, and dirceted all recraational activities

for a group of 50 delinquent girls under the jurisdiction of the Youth Authority.

1963, 1964, S

965

Fastside Settlement House

Los Angeles, California

COUNSELOR/INSTRUCTOR (summers and part-timc)

Initiated a math tutoring program. Assisted in obtaining employment, job

development and training programs, and recreational activities. Sought to

subtly mold and change the ideas and beliets of juveniles, specifically regard

ing the need for education, and the ability to accept re-ponsibility and put

forth self improvement. Also, presently a member of the Board of Directors.

PERSONAL DATA

REFERENCES

Native Californian, born September, 1970. Single. Health excelient. Wiling to

travel, and to relocate. Ü. S. Citizen. Bondable.

Professor Lawrence Sullivan

Boalt Hall School of Law

University of California at Berkeley

Berkeley, California 91620

(415) 612-2273

Mr. Henry A. Talbert

National Urban League, Inc.

Director, Western Regional Office

4055 Wilshire Boulevard, Suite 526

Los Angeles, California 90010

(213) 381-5643

Dr. Gail Wyatt

UCLA Neuro Psychialric Institute

750 Westwood Plaza

Los Angeles, California 90027

(213) 825-0193

NW 66000

Docld:32239451 Page 18

---

## Page 19

PERSONAL QUALIFICATIONS STATEMENT

1A. Kind of positon (job) you are filing for (or lisle of

B. Agnouncement No.

announcemes Legal or Semi-Legal

C. Options for which you wish to be considered (if lissed in annuam mens)

oice o: Manakement and Huds

Approved 30-RO387

DO NOT WRITE IN THIS BLOCK

FOR USE OF EXAMINING OFFICE ONLY

Matanal

Entered Regisier:

Submitted

SELECT COMMITTEE

D. Primary place (s) you wish to be emproved

Anywhere in the D.C.

area

2. Home phone (including Ared Code)

30]

599-6349

Othce

phone (including Area Code)

(202)

225-7084

4. Name (Last) (First) (Middle)

and Address (Number, Siries, Cly, State and ZIP Coll Mr.

(Maiden, 3y 071)

Holt,

Laura Mae

2034 Taylor Run

Andrews AFB; MA: 2033]

_ Appor.

• Nonappor.

Notations:

Returned

Form Reviewed:

Form Approved:

Option

Grade

Earned

Rating

Preferenc

Лид.

Pacing

3 points

(Tert.)

3. Legal or voring residence (Siase)

Calitornia

10 Points

Comp. Dis.

Other

10 Points

6. Height without shoes

5 Fert _

Weight

140

8. Birchplace (City and Stase, or foreige country)

Los Angeles, Calitornia

Вертетьст" 20, 1946° 555728-538

11. If you have ever tren employed by the Federal Government as a civilian, give your

Lass classification series, grade, and job title.

Disal.

Initials and Date

Being

Investi-

gated

N.A

Dares of service in that grade

From

THIS SPACE FOR USE OF APPOINTING OFFICER UNLY

Preference has been verifed through proof that the separation a3

under honorable conditions, and other proof as required.

_ 3-Pr.

10-Pr. Comp. Disab.

10-Pr. Orher

To

Signature and Title

12. I you are currentiy on a list of eligibles for appointment to a Federal position, give

the name of the announcement, the name of che offce maintaining the list, the dere

co your sorice of rating, and your rating.

Agency

Date

Refer for medical action

N.A.

13. Lowest pay of grade you will accept

14. When will you be

PAY

available?

GRADE

3 Open

per

OR

13. Will you accept cemporary employment for:

YES

Immediately

16. Where will you accept a job?

YES

• NO

(Ariegsance or aspisaloy

-_1 monch of less?

17. Will you accept less than full fine work?

_ Washington, D.C.

(Less shams 40 bours pir wrek)! Yes

Iporary enople sons will

_ No

not affece your consideration

-any place in the United States.

18. Are you willing to travel? (Chock to)

for older appointmenis.

_4 80 12 months?

_Ourside of thè United States.

*

NO

Only in (specify):

SOME

LOFTEN

19. VETERAN FREFERENCE. Answer all parts. If a past does not apply to you, answer "No."

A. Have you ever served on active duty in thé United States milicary service? (Exclude fours of active duty for training as a reservise or Guardsman.)

B. Have you ever been discharged from the armed services under other than honorable conditions? (You may omit any such discharge changed

to honorable by a Discharge Review Board or similar authority.) :

If "'Yes," give details in liem 37.

C Do you claim s-point preference based on active duty in the armed forces?

If "Yes," you will be required so furnish records so suppore your slaim as the time you are appoint:d.

D. Do you claim 10 point preference?.

If "Yes." dece ope of prejerence claimed and complete and asach Standard ferno Is.

"Claim for 10-poini Veieran Preference," dogether wish she proof

TYPE: [ Compensable disability

licit for

• Disability

ifocher

E. List Dates, Branch, and Serial or Service Number of All Active Service (Enter "N/A" if nos applicabie)

From

To

N.A

THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMFLOYER

Branch of Service

Serial or Service Number

Page 1

Standard Form 171

May 1975 U.S. Civil Service Commission

171-105

NW 66000

Docld:32239451 Page 19

---

## Page 20

PLEASE BE SURE TO KEND ATTACHED INSIRUCTIOINS BE CHE CONGLENGE HEM 20

20. ExPERiERCE ASiar WiRE your PRESENT pastion and were tack saose for period o are logans in separato adi to rair.)

May inquiry be male of your piesens emploje: regarding pour choraues, qualibiaions, and record if emmpioyincai?..

(A"No" will r0i uffns your consideration for engloyment apfortunisies erier fur HERiNG ENMITiER pisitiors.y

Dates of employineni i monib, Jia?)

Exact title of position

If Federal service, cisilian os railid

1

From ¼ 1971

To PRESENT TIME- 1.976

LAWYER 1974-76

juniter and kind of craployees

Salary or earnings

Avg. hrs.

Place uf en:ployment

Stating $ 16,000

pr year

per weck

CityL. A.

supervised

grade

886.1

Kind of business or orparizati

Pres:ne $ 25,

767 per

year

50+

sa: Calif.

None

Law Firm

name of immailiate supeivisor

Name of employer (frrs, organization, eir.) and address (including ZIP Code, if kru::)

Rose Hemperley

Rose Hemperley,

117 Swest 9th Street

Area Code and phure No. irkrown (213) 622-2075

Hosen for many we I wish to move East with my tamily?

• California 90015

Description of duties, iesponsibilities, and accumplishments

Private law firm pracgicing corporate, civil, domestic relations,

criminal, and tax law. Extensive research in the above areas as

well as writing briefs and memoranda. Making court appearances and

jait visits.

For agency use (skill codes, esc.)

Dates of employment (münth, gear)

Exzct title of position

If Federal service, civilian or mili

2

From 1967

To 1968

Coordinator of Youth

grade

Salary or caruing:

Kind ONiustness or organiza

Starting $

per

Finals $12,00 k year

Arg. hrs.

per week

40

Place of employment

Number and kind of eniployees

City L.A.

supervised

(П4ащЖ84178.В6С0498Ng, iNSuTE

SearCalif.

None

e.) Community Men

Name of immediate supervicos

Name of employer (him, organisation, ai.) and address (hea Encolentey

Horace Austin

Central

City Community Mental Health

Area Code and prore No. if kriown (213X 232-4111

4211 South Avalon Blvd. L.A. 90011

Reason for leaving

Left to attend Law School full time from 1968-1971.

Descripiion of durics, responsibilities, and accomplishments

Evaluated and recommended workable solutions to juvenile problems on

an individual and group basis.

Served as lasson and coordinated

with outside agencies. Attended juvenile court hearings.

For agency use (skill cass, esc.)

Daces of er.ploynent (monib, year)

Exzer title of posison

From 1966

To 1967

Basic

Skills Instructorgade

li federal service, civilian ce rail

l.A.

Salary or earnings

Arg. hrs.

Place of employment

Number and kind of employess

Kind of business or bigain

Scarring $

per

per treck

CityL. A.

supervised

(minefasturing, accounting, insar

Final $ 10,000

per

year

40+

ScareCalif.

None

*. Youth Trainin

Naohn sisterior

Name of empicyes (frm, urganization, e)ind address (lype ey

Youth

Training &

Employment Project

Area Code and pliane No. ifknuwn(213), 757-8771

9027 South Figueroa L. A. 90003

Rezson for leaving

Accepted a better paying job with greater potential to advan

Description of duties, responsibilities, and accomplishments

Taught basic english,

writing and math to high school drop-outs betw

the ages of 16 and 21.

1965 Full time employee at Ventura School for Girls. 3100 Wright Rd

Camarillo, Calif.

Fall of 1963-65 Fall time graduate student

1960-63 full time college student

1950-59 High School student

IF YOU NEED ADDITIONAL EXPERIENCE BLOCKS USE STANDARD FORM 171-4. OR BLINK SHEETS

SEE INSTRUCTION SHEET

Page 2

NW 66000

Docld:32239451 Page 20

---

## Page 21

ATTACH. SUPPISMENTAL CALCIS GO TORME NE

• ANSWER ALL QUESTIONS CORRECTLY AND FULLY

21 A. Special jualifications and sailis (skulls with martenes, pascats or insunsions, your moss infordars piblications (do no submiis copies piless equesied), lude publis

speaking and publications experience; membership in frofessional or scieninto sociesies; esc.).

Member, Pennsylvania Bar

B. Kind of License or

Cerificate (For example, pilos,

regiles aerse, laidger, radio operator, C.P.A., 65c.)

Lawyer

C. Stare or other licensing authority

Pennsylvania

D. Year of frise

license

19 grificate

E. Year of latest

licerise

F. Approximaie dumi

of words per minut

Typing

Shorthai

41

22. 1. Did you

graduate trom high school, or will

you graduate wichin the next nine months?

Jah! 759

HIGHEST GRADE COMPLETED

¡ace and location (city, Stase, and ZlP Code if knoun) of collese

or university.

(If you expeci do graducte within 9 monibs, give

MONTH and year rou expeit degrce.)

Cal State University at b.A.

and I. A. Pacifie College

B. Name and loation (city and Stats) of last high schost atiended

Dorsey High School, Los Angeles, Calif.

Dares attended

Years Completed

No. of credits commel.

Type of

From

To

Day

Beinster

Quaiter

Night

degree

hours

hours

У В. Л., ек.)

Year

de gt:

D. Chief undergraduate college subjects

Sociology & Poli Sei

950

No. of credits compl.

Semester

Quarter

hours

hours

35

1963

X 4

yrs.

124

E. Chief graduate college subjeces

Law J.D. 1971

B.A.

196

No. of crediis co:

Semestes

hours

Qua!

hou

180+

ofpapate he consumer

Law, Constitutional Law, Minority Business

G. Other schools or training (for escmple, srade, vocational, anned forces, or business). Give for each the name and location (city, Sidle, and ZIP Code if kiown) "

school, dares atter.ded, subjects siudied, number of classroom hours of instruction per week, certificates, and auy other pertinent data.

Boalt Hall School of Law

University of California at Berkeley

Berkeley, California 94620

23. HONORS, AWARDS, AND FELLOWSHIPS

RECEIVED

Martin Luther King, JI.

Fellow.

24. LANGUAGES OTHER THAN ENGLISH

List the languages and indicate

your knowledge at each by

hire nich proper columns

Reading

Exci Good jair

Boalt Hall School of Law

Board Member Eastside Settlement House

Speaking

Understanding

Wiriti

25.

REFEP.ENCES. List threa persons iio ais NOT relaid to you and tiho have definite knowledge of your qualificaiions and finess for the position fur whi

you are applying. Do no: repeat names of supervi.ors listed under Item 20, EXPERIENCE.

PRESENT BUSINESS OR HOME ADDRESS

BUSINESS OR OCCUPA

FULL NAME

(Number, Street, City, State ind ZIP Code)

-6706 Lincoln Drive

Merle Hughes

Philadelphia, Pa. 19119

Lawyer

Western Savings Bank Bldg.

Ron Merriweather

Suite 911 Btoad & Chestnut St.

Phila. Pa. 19107

Katherine Tooks

3087 Manning Ave. L. A. 90064

LawyeT

Lawyer

Page 3

NW 66000

Docld:32239451 Page 21

---

## Page 22

ANSWER ITEMS 26 THROUGH! 36 BY PLACING AN "X" IN THE PROPER COLUMN

Are you a citizen of the United States?

If " No.

give country a which you are a cirizen

Belore answering ibese questions read liems 27 and 28 in she altached instrucsions.

27. Are you now a member of the Communist Parry, U.S.A., or any subdivision of the Communist Parry, U.S.A.?:

28. (a) Are you now, or within she last ten years have you been, a member of any organization, or group of persons including but nor limired

to the Communist Party,

which during the period of your membership you knew

was advocating or teaching that the rovernment of the Unired States of any political subdivision thereof should be overthrown or overturned by

force, violence, or any unlawful means?.

28. (b) If your answer to (a) is in the affirmative, did you, during the period of such membership, have the specific intent to further the airns of

such organization or group of persons to overthrow or overturn

the government of the United States or any state or any political subdivision

thereof by force, violence, or any unlawful means?....

29. If your answer to 27 or 28fa) above is in the affirmative state the nanies of such organizations and the dates of your membership. in each in.

item 37.

30.

31.

Within the last five years have you been fred from any job for any season?

Within the lasi five years have you quir a job after being norified that you would be fired?

If your answer in 30 or 31 above is

"Yes,"

size desails in liem 37. Show she name and adúress (including ZIP Cods) of employer, approximate dase, and

• ressons in each case. This information should agree wish your ansuers in liem 20, EXPERIENCE.

32. Have you ever been convicted of an offense against the law or forfeited collateral, of are you now under charges for any offense against che law?

(You may omit: (1) traffic violations for which you paid a fine of $30.00 or less; and (2) any offense committed before your 2ist birthday which

was finally adjudicared in a juvenile court of under a Youth Offender law.)..

33. While in she military service were you ever convicred by general court-martial?.

If your ansuer so 32 ox, 33 is "Yes," give desails in liem 37. Show for each offense: (1) date; (2) charge: (3) place; (4) cours; and (S) action saken

Yes

No

X

X

34. Does the United States Government employ in a civilian caparity or as a member of the Armed Forces any relative of yours (by blood or marriage)?

(See Items 34 and 35 in the attached instruction sheet.) ..

35. Do you live with, or within the past 12 months have you lived wich,

any of these relatives who are employed in a civilian capacity?

If your answer to 34 is "Yes." give in liem 37 for such relatives: (1) full

name; (2) present address (including ZIP Cods): (3) relationship: (4) depars.

mens, agency, or branch of she Armed Forces. If your ansuer so 35 is "Yes,"

also give the kind of appoinimeni beld by she relativals) you live with or have

lived with within the pass 12 morths.

X

36. Do you receive or do you have a pending application for retirement or retainer pay, pension, or other compensation based upon military, Federal

civilian, or Districe of Columbia Government service?......

If your arsuer is ''Yes," gie dessils in leem 37.

Your Stasement cannos be processed until you bave answered all questions, including liems 26 through 36 above. Be sure you bave plaied an "X" to she lefe of EVERY

marker (st) above, eisher in tbe "Yes" or sbe "No" column.

37. Space for detailed answers. Indicate Irem number to which answers apply.

Item No.

34

Kenneth Michael Binion, Nephew

4409 S. Harvard

LOS

Angeles, Ca. 90062

U.S. Marines

If more space is required, use full sheets of paper approximately the same size as this page. Write on EACH sheet your name, birth date. and announterens or

posision title. Artach all sheets to this Starement at the rop of Page 3.

ATTENTION - THIS STATEMENT MUST BE SIGNED

Read the following paragroph carefuily before signing this-Stalement

A falao answer to any quastion in this Staraniani may ho grounds for not amploying you, or for dismissing you after you begin.

work, and may ba punishable by fine or Imprisonment (U.S. Codo, Tille 18, Sac. 1001). All statumonto are subject lo barasiigattor

induding a chact of your Angorprinis, polica racords, and formor employars. All the Information you give mill bo consloorod is

revlowing your siatomons and ls sublast so invastlaction. A false unsvior to lioms 27 or 23 could depriva you of your right to oi

annulty whon you rosch ratireriant ogs in addition to the penaltios desertbai abova.

CERTIFICATION

SIGNATURE (Sign in ink)

DATE SIGNED

I CERTIFY that all of the statements made in this Stacement

are true, complese, and corsect to the best of my knowledge

and belief, and are made in good faith.

ale the tilt

Page 4

OPO

9-29-76

+45-18-81181-2

4:4-

NW 66000

Docld:32239451 Page 22

---

## Page 23

LACRAMAE HOLT=

2034 Taylor Run

Andrews AFB, Md.

20331

(301) 599-6349

DEC 11910

1754 West Adams Boulevard

L06 Angeles, Califomia 90018

Telephones:

(213) 735-6348

(213) 734-4941

EDUCATION

Boalt Hall School of Law, University of California, Berkeley

J. D. Degree - 1971

Los Angeles Pacific College - Los Angeles, California

B. A. Degree - 1903,

Major: Sociology

Minor: Political Science

MEMBERSHIP

Member, Pennsylvania Bar Association

PROFESSIONAL EXPERIENCE

1971 - 1975

Rose Hemperley, Attorney at Li

117 N. 9th St., Los Angeles, C:

- Telephone: (213) 622-2075

LAW CLERK

Private firm practicing corporate, civil, domestic relations, criminal, and tax law.

1970 - 1971

White and Cruickshank

Attorneys at Law

Oakland, California

RESEARCH ASSISTANT (part-time)

Served as Research Assistant to Mr. Clinton White in this firm practicing criminal

law. Soine exposure to trial work. Aiso, Assistant Editor/Research Assistant to

Professor Robert il. O'Neil at Boill, during this period.

1967 - 1968

Central City Community Mental

Health Center, Los Angeles, Cali

COORDINATOR of Youth Activities

Evaluated, and recommended workable solutions to juvenile problems, on both an

individual and a group basis. Seried as liaison and coordinated with outside agencies.

such as Police Department and Sheriff's Office.

Allended juvenile court hearings.

Participated in formuiating and inplementing programs.

1966 - 1967

Youth Training & Employment

Project, Los Angcles, Calif.

INSTRUCTOR in Basic Skills

Taught basic kinglish, weting aud

inathematies to school dropouts betwcen 16 and

21. Counseled, tested and graded, and provided assistancr on specific problems..

Was sucressful in persuading a sigmificant number of my students to relin to

formal schooling..

both academie and trade.

N 66000

Dộcld:32239451 Page 23

---

## Page 24

LAURA MAE HOLT

Page Two

PROFESSIONAL. FNPERIENCE (Continued)

1965 - 190

Ventura School for Girls

Camarillo, California

GROUP SUPERVISOR

Evalu ted girls, composed behavior and progress reports, participated in group

counseling, set up and supervised programs, and dirceted all recreational activities

for a group of 50 delinquent girls under the jurisdiction of the Youth Authority.

1963, 1964, & 965

Eastside Settlement Horse

Los Angeles, California

COUNSELOR/INSTRUCTOR (summers and part-time)

Initiated a math tutoring program. Assisted in obtaining employment, job

development and training programs, and recreational activities. Sought to

subtly mold and change the idcas and belicis of juveniles, specifically regard-

ing the need for education, and the ability to accept responsibility and put

forth self improvement. Also, presently a member of the Board of Directors.

PERSONAL DATA

REFERENCES

Native Californian, born September, 1940. Single. Health excellent. Willing to

travel, and to relocate.

U. S. Citizen. Bondable.

Professor Lawrence Sullivan

., Boalt Hall School of Law

University of California at Berkeley

Berkeley, California 94620

(415) 642-2273

Mr. Henry A. Talbert

National Urban League, Inc.

Director, Western Regional Office

4055 Wilshire Boulevard, Suite 526

Los Angeles, California 90010

(213) 381-5643-

Dr. Gail Wyatt

UCLA Ncuro-Psychiatric Institute

750 Westwood Plaza

Los Angeles, California 9002*

(213) 825-0193

NW/ 66000

Docld:32239451 Page 24 •

---

## Page 25

YVONNE BRATHIAITE BURKE

28TH DISTRICT, CALIFORNIA

COMMITTEE ON

APPROPRIATIONS

Congress of the United States

House of Representatives

Bashington, D.C. 20515

September 23, 1976

Dear Rick:

Mrs. Burke wanted your boss to have this

resume immediately so I

am imposing on your

good nature to get it before him ASAP. She

has evidently discussed Ms. Holt with

him dur-

ing

sessions on the floor.

Thanks for your help.

Regaras,

Wendell

Wendell M. Holloway

upplicate

NWV 66000

Docld:32239451 Page 25

---

## Page 26

TEMPO, ON MRS. BURIES STATE -

MAE HOLT

2034 Taylor Run

Andrews

AFB, Md.

20331

(301) 599-6349

HOLT

RICK

173y West Adams Boulevard

1.08 Angelra, California 80018

Telephones:

(213) 735-6348-0

(213) 734-1951

EDUCATION

MEMBERSHIP

Boalt Hall School of Law, University of California, Berkcley

J. D. Degree - 1971

Los Angeles Pacific College - Los Angeles, California

B. A. Degree - 1903

Major: Sociology

Minor: Political Science

Member, Pennsylvania far Association

PROFESSIONAL EXPERIENCE

1971 - 1975

Rose Hemperley, Attorney at Law.

117 D: 9th St., Los Angeles, Calif

LAW CLERK

- Telephone: (213) 622-2075

Private firm practicing corporate, civil, domestic relations, criminal, and tax law.

1970 - 1971

White and Cruickshank

Attorneys at Law

Oakland, California

RESEARCH ASSISTANT (part-time)

Served as Research Assistant to Mr. Clinton White in this firm practicing criminal

law. Soine exposure to trial work.

Aiso, Assistant Editor/Research Assistant to

Professor Robert M. O'Neil at Boalt, during this period.

1967 - 1968

Central City Community Mental

Health Center, Los Angeles, Callf.

COORDINATOR of Youth Activities

Evaluated, and recommended workable solutions lo juvenile problems, on both an

individual and a group basis. Seried as liaison and courdinated with outside agencies,

such as Police Department and Sheriff's Oifice. Allended juvenile court hearings.

Participated in formuiating and inplementing programs.

1966 - 1967

Youth Training & Employment

Project, Los Ingeles, Calif.

INSTPUCTOR in Basic Skills

Taught basic English, writing and matlematics to school droponte betucen 16 and

21. Counseled, dated and graded, and provided assistaner on specifie problems.

Was successful in persuading a significant number of my students to retarn 1o

NW 66000

formal schooling. both academic and trade.

Docld:32239451 Page 26

---

## Page 27

LAURA MAE HOLT -

l'age Two

PROFESSIONAL, ENPERIENCE (Continued)

1965 - 190

Ventura School for Girls

Camarillo, California

GROUP SUPERVISOR

Evalu ed girls, composed behavior and progress reports; participated in group

counseling, set up and supervised programs, and dirceted all recreational activities

for a group of 50 delinquent girls under the jurisdiction of the Youth Authority.

1963, 1964, &

965

Eastside. Settlement- House

Los: Augeles, California

COUNSELOR/INSTRUCTOR (summers and part-Limc)

• Initiated a math tutoring program. Assisted in obtaining employment, job

development and training programs, and recreational activities.. Sought to

sublly mold and change the idcas and belieis of juveniles, specifically regard.

ing the need for education, and the ability to accept responsibility and put

forth self improvement. Also, presently a member of the Board of Directors.

PERSONAL DATA

Native Californian, born September, 1940. Single.

Health excellent. Wiling to

travel, and to relocate. U. S. Citizen. Bondable.

REFERENCES

Professor Lawrence Sullivan

., Boalt Hall School of Law

University of California at Berkeley

Berkeley, California 94020

(415) 612-2273

Mr. Henry A. Talbert

National Urban League, Inc.

Dircctor, Western Regional Office

4055 Wishire Boulevard, Suite 526

Los Angeles, California 90010

(213) 381-5643

Dr. Gail Wyatt

UCLA Neuro-Psychiatric Institute

750 Westwood Plaza

Los Angeles, California 90027

(213) 825-0193

NW 66000

Docld:32239451 Page 27

---

## Page 28

December 2, 1976

Honorable Yvonne B. Burke

U. S. House of Representatives

Washington, D. C.

20515

Dear Congresswoman Burke:

Please be advised that with regard to your recommendation

of Ms. Laura M. Holt we have interviewed her, and concur with

your evaluation of her.

We have hired her for the position of staff counsel,

and she will commence work here on December 31, 1976.

Sincerely yours,

Richard A. Sprague

Chief Counsel and Director

RAS/ca

NV 66000

Docld:32239451 Page 28

---

## Page 29

EDWARD W. BROOKE

MASSACHUSETTS

DEC 11876

ATTORNEY

@nited States Senate

WASHINGTON, D.C. 20510

October 1, 1976

HOLT

COMMITTEES:

BANKINAN USING AND

SPECIAL COMMITTEE ON AGIN

STANDARES AND CONDUC

2003-F KENNEDY FEDERAL BLOG,

88172, 72203

202-224-2742

fiscalved In the lashington Office

OCT 8 1976

The Honorable Samuel L. Devine

House of Representatives

Room 2206

Washington, D. C. 20510

Dear Mr. Devine:

It has come to my attention that Ms. Laura M. Holt

(2034 Taylor Road, Andrews Air Force Base, Maryland) has

applied for a legal position on the House

Select Committee

on Assassinations.

From all that I have been able to learn of her,

she is a woman of intelligence, dedication, and drive,

who would serve with distinction in any position she

should undertake.

I hope that it will be possible for you personally

to review her application and to give her interest the

closest consideration.

With appreciation for your assistance and

consideration, I am,

Sincerely,

EWB: rk

Enclosures

cc :

Mr. John S. Hoyt

NW 66000

Docld:32239451 Page 29

---

## Page 30

Laten

MAE HALT

1501 West dcan Docleraid

Los Angeles, Califomia 90018

Telephones:

(213) 735-0578

(213; 734 4941

EDUCATION

MEMBERSHIP

Boalt Hall School of Law, University of California, Berhcley

J. D. Degrce - 1971

Los Angeles Pacific College - Los Angeles, California

B. A. Degree - 1963

Major: Sociology

Minor: Political Science

Member, Pennsylvania far Association

PROFESSIONAL EXPERIENCE

1971 - 1975

Rose Hemperley, Attorney at I

117 N. 9th St., Los Angeles, Ca

Telephone: (213) 522-2075

LAW CLERK

Private firm practicing corporale, civil, domestic relations, criminal, and tax law.

1970 - 1971

White and Cruickshant:

Attorney's at Law

Cakland, California

RESEARCHI ASSISTANT (parl-time)

Served as Research Assistant to Mr. Clinton White in this firm practicing criminal

lan: Some exposure to trial work. Aiso: Assisian: Editor/Research Assistant to

Frofessor Robert M. O'Neil at Boal, during this period.

1967 - 1968

Central City Community Mental

Health Center, Los Angeles, Call

COORDIXATOR of Youth Actnities

Evaluated, and recommended workable solutions to juvenile problems, on both an

individua and a group baris. Seried as liaison and coordinated with outside agencies.

such a: Polie: Department and Sheriff's Office. Aitended juvenile court hearings.

Participaicd in formpisting and implementing programs.

1966 - 1907

Jouth Training & Employment

Project, Los Angeles, Calf.

TSTHACCOR in Basic Skills

Taught basie Laglish, deiting and mathematies to school dreponte between 16 and

21. Counseled, reded and graded, and provided assistance on specific problenis.

Was suorcesful in persuading a sinificant mimber of my studente to retirr 1o

tomas chording too. both acadrade and trade.

NW 66000

Docld:32239451 Page 30

---

## Page 31

LAURA

MAE HOLT-

PROFESSIONAI. FXPERIENCE (Continued)

1955 - 196

lage Two

Ventura School for Girls

Camarillo, California

GROUP SUPERVISOR

Evalu ted girls, composed uchavior and progress reports, participated in group

counseling, set up and supenised programs, and dirceted all recreational activities

for a group of 50 delinquent girls under the jurisdiction of the Youth Authority.

1963, 1967, & 965

Eastside Settlement House

Los Angeles, California

COUNSELOR/INSTRUCTOR (summers and part-time)

Initiated a math tutoring program. Assisted in obtaining employment, job

development and training programs, and recreational activities. Sought to

subtly mold and change the idcas and belicis of juveniles, specifically regard-

ing the need for education, and the ability to accept responsibility and put

forth self improvement. Also, presently a memher of the Board oi Directors.

PERSONAL DATA

Native Californian, born September, 1940. Single. Health excelient. Willing to

travel, and to relocate. U. S. Citizen. Bondable.

REFERENCES

Professor Lawrence Sullivan

Boat Hall School of Law

University of California at Berkeley

Berkeley, California 91620

(415) 612-2273

Mr. Henry A. Talber

National Urban League, Inc.

Direcior, Western Regional Office

4055 Müshire Boulciard, Suite 520

Los Angeles, California

90010

(213) 381-5643

Dr. Gail Hyatt

UCLA Neuro-Psychiatric Institute

750 Westwood Plaza

Los Angeles, California 90027

(213) 825-0193

NW 66000

Docld:32239451 Page 31

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## Page 32

10521-02.50m1

1egel

Senate sub committee on

Farine,

Inter-

itemares:.

DO NOT PATENTASE-

FOR USE OF EXAMINING GERICRETDY

Lateral

Enero AT-=

Subaitird

/Ferames

inywhere in the washingion, D.C.

Cona Baone (irrading Are Gestj

5. Ohe phone liarinding Ares Cude)

(213) 735-6348

((213) 734-4941

tristie)

area

Form Rovirard

Form Approrre:

NANONGONNY

Opcios

Graje

ained

Holt,

.Laura Mae.

1739. west Adams. Blva.

Los Angeles, California 90018

3 pix-=

0÷-.

california

ó, raighe exanou: aboz

t0 Fera

=. Erica

1135

Los angeles, califormie

D

STATMENT NO.

inicais zoo Date

Septe 24, 1240

an: cantasaon series crade. and

559- 28

5030

De Frand Ganararaet asa cirian, gira yout

THIS SPACE FOR USE OF AFPOINTING OFFICER ONLY

referente has beer roañod derounn proo: tar: tD: S0p22:5r. 67

inde pocomble condadona, and othe: prosi araguas

N.A.

==:=: cinerce in that gride

Era el tie cancancement Die rara ditar Shice Estang Ge Hi, Che Cie

Satan

Eres

Feia: ter medici arjos

1.4.

→= 2: 0: 17de VeR 50.20019

-_Inmediately

...

-:

tie te te Water tais.

- .

..=.

teneint"

.ttti10=.n1

ta che ter

1.1111 117111

.?::

.:

N.A.

NW 66000

Docld:32239451 Page 32

---

## Page 33

To PRESENT 7MB076

Let MerA

1id d 19:2165

Arg. it's.

Place of employmeni

Nursie and ind ei erplayes

Sent of Fema ai

ganns:10,000 k yeer

Ciry: I. A .

or.)

Piani: 25,762

* year

504

Stare Calit.

none

LEn Firm

Name of immediate supervisor

Name of emplove (jani organization, en.) and address financing aiF sud, i encuri

Rose

Genderley

Rose Hemperley, 117 nest gib Street

Nes Giar and phone No. ilknoat 273) 622-2075

Los angeles, California 90015

F-sor fo: wanting roleac I wish to move east wiüh mi family.

Inciation of duties, responsibilities, and acco oplishments

Private law firm practicing corporate, civil, domestic relations,

chininal, and tar law.

EstersivE rasearch in the above ereas

zs well as writing briefs and memoranda, laning court apperzarces

and jail visits.

For spency use (iRili ai., eic.)

Daiss of employmedi (marik, gear)

15T077067

Exati tirie of posision

li Froeral serrica, civilian oi multary

To

1968

tig. hrs.

pe week

coordinator of youth

Face N. A

Piace of empioimen:

Number and kind of employees

Kind of business di diganization

Ciry: I.. A.

supervised

. Community tental

Fai's 12

.000

Nate of tamediate supervisor

per yean

40

Sare: Calif.

None

Center

Name of employei (jam orestination, ery and address (inducte ZiF Cose, l EROsT)

Central City Community Mental realth

Lo Code and phore No. Minown (213.

232-4111/4211 South Avalon Elva. L.A.

90011

Fam for isre left to attend Law School full time from 1968-1971

Dantipoor of duties, responsibilites, ane accomplisaments

Baalusted and recommended workable solutions

to iuvenile problems

or an individual and group basis.

Served as

laison and coordinatad

witin outside agencies. Attended

juvenile court hearings.

Dates si employment (month, year)

Ten 1966

Fatart ci saching:

SIRTUE E

Frs: 10.000

Piece al tamiedate supervise:

¡Eran titia of posizion

if Federal terman, civilian or Siiary

To 1902

basic Skills Instructor and.

Piace of easionment

Jamierand lind of capity =:

Mind si busteer: co

supervised

eVEET

4C saCalif.

None

Employment

Hame of empiore: from. orgenicion, did and cleree fiReberg

Training ano

Employment

Froject

is code sid sha lo. Feror: (213) 757-8771

9027 South Figueroe

90005

a netter perine job mith ersater potential to advance

Tanant basic english vriting and math to nigh school ero=-outs

hatrean the pres di 1ó and 21.

10ÁE FUT time employas at ventura School fon Girls, 310a rian:

General dee

==11 0f 1063-65 Full time graänete studeri

1050-1063 full time college student

1956-1959 High sarnal student

IF YOU NEED ADDITIONAL EXPERIENCE BLOCKS LSE STANDARD FORM 171-4. OR ELANE ERESTS

SEE INSTRUCTION SHEET

Fage ?

NW 66000

Docld:32239451 Page 33

---

## Page 34

rebber, Pennsylvania Bar

B. Kind ol Licens: or Carace lFor cierpie, piloi,:

regisinà manse, lEnges, radic apriclor, C.P.A., 815.)

C. Suate or other licensing authority

D

Lawyer

Pennsylvania

j'eai of firsi

E. Year. of latest

license

license

or certifcate

or centibcale

1974

1975

Snorinand

22. A. Did as graduate from high school, or sill

von Faduas within the noz: nine boaths:

MONTROLO

HIGHEST CADR SOMPLETED

Malian.

159

C.

B. Name and location (cisy and Stale) of lasi high scioul arended

Dorsey High School,

Daies attended

Years Compiered

From

To

Day X! Nigh

11960|1963

Los Angeles,

No. a ordio comp!.

Semestei

hous

hates

1724

Calif.

Type of

Year of

California State University at

Los ingeles; los angeles

Pacific College

D Chid unde graduate coliege subjeces

B.A.

1963

No. of credits compl.

¡ Semesier i Quarier

hours

" E. Chié graduate colice subjeces

Sociology & Folitical Science 35

Lan

No. of credits compl

Semeter i Quate

hour

tours

180T

F. Majo: feld d study at highes: levej of college work

socialcan and Folitical Science

8. Our s:ho59: rainine 12 coarsis Mad peauered armed jore, or bunes. Give for each the name and location (rin, fiale, end ZIP Code i knour; Oi

chool, dates armand, rubines studira, numbe of riassroom hours d insirucdon per acen, cerubcales, and any other pertinent dai

25..

HONORAXPARDE AND FELLOWSEPE

REWED

=

I.

Si- 3021

ThEn

1965

A795:

Häl

S0h001

24

LANGUAGES OTHER THAN ENGLISH

Lis: the languages and indicat

Reading

You Bacalciet

o! tach D!

Pating an

in proper columna

Sotziang

indemanding

Exci Good Fair Exo Good Fee 'Exa Good Fait Bxd Good|Fair

French

Thing

12.

- an arging Di hai topest named at siterson third under item: 24.

EXFEPIEN CH

PRESENT BUSINESS OF HOME ADDRES:

(Number Jiree, City, Siali and ZiF Cuäs:

308? Manning Ave.

Ratherine Tooks

IOs Angeles, Ca 90064

Sonnader, Harrison, segalabewas

§retor Butcher Meison

1719

Fackard Building

Philadelphia, Pa. 19102

we Bon herrinesther

western Savings Bank 3105.

Suite 90911

Broad

Philadelphia,

BUENESE OR OSCUPADION

ReborDer

Attorner

NW 66000

Docld:32239451 Page 34

---

## Page 35

EX COLUM

•any subdivision of the Comans Rate ted..

let are you nost ei eran the lot ten Prat herd you been a betibe: di any organizaton, bi earn ef menons indiading but ter liaim

/tis

unitaris: carto tard. D' and substasion pi the Cocamunis: Fami, 0.5.4, whis

irathung than the porerameni ci the Liated Got or any poinical subdivision tiereci chould in overaroso di armurbed Ey

force, violence, or any antasini meantie.....11101.

51 le you: answe: so lai is ia the sarmatre, did rou. during the period ei such membershia, have the specife inions to further the aires oi

Janed Saies do any sarce any polace!

inciest by force, vioicace, co ang paisatal Jranc?..

wardition.

59. I pout abome: to 37 ot ZPtal abode is in ibe afimatire seir ine names di such organizaions and the dates of your responder to rach ia

10................10111111111.11.................

Cahua the los doe gear care you been fred from dogget tor any teason?

Within the last hue peats hate you gottenon aier toung horind that you mould be fies?

nino antart it Be DeSpairie 13

Ten informatio socals ages auth dont detonate tire 20. EXPERDENCE.

Hare you rue: been conviced bi an efeat desin the len er farteurd collateral on de you mom when charges for and earnserteen the lead

¡ee may era, ily trame visitions to eluca you paid i doo Sto90.00 or lessiand 12j any oãtase committed before your Diet faraday ebret

135.

= irie in the milliary service seis you ever convined by deneral coca-marial:

:. Does the Mated Sages Goveramon: empioy in a civilian capacity en 18 a moriber ci che daged Forres aag relative si your Cy blood ee masteria

Fee head to and as in the anached indecation saceiy.

Pe you lee aul. ei mean ine 925: 12 mooths here you dred auth say of there relaures aho are cabioged in a civilian capacit

"jes" punte deem 37 for tach relates 01220

Do you migue on de vou have i pending application ion causereni ei teaune: paj, pension ci Difci corpensation based upon Finery, Feerra!

corian, er Discia: of Colombia Ganenment cervicel....

iner: ter Cetalied zasmers, Indiet Item nombs to ahith aaamer: 22015

34

Kenneth Michael Binion, Nephew

4409 S. Harvard

Los Angeles, Ca. 90062

Marines

Statement at ten tet ei

maris periorte

indecine ecosta ot

Petit

Cora.

This tE.

112kR.I5n

are ret

Sitionam ana i subiod to investigator a taion and mento load arE 20 could deptire rot ei

CSTTRICATION

1007TEE the 600i the Rent tents made in this Gatement

and inish aid and made in good tart

E.T. 5EN3a

/June ?, 1975

г...—;..

NW 66000

Docld:32239451 Page 35

---

## Page 36

ATTORNEY

HOLT

DEC

1.1976

October 6, 1976

Dear Mr. Hoyt,

I have been referred to your office via Ms. Krol from

Senator Brooke's office.

I am a registered Republican, new in town, and a licensed

attorney. I would like a staff position on the Assassination

Committee.

If this is not possible,.

as I realize the many applications

your office gets, please do whatever you can on my behalf in

other areas of sub-committees as they become to your attention.

Thanking you I

am,

Sincerely, yours,

Lave tatt

Laura Holt

NW 66000

Docld:32239451 Page 36

---

## Page 37

YVONNE BRATHWAITE BURKE

28TH DISTRICT, CALIFORNIA

COMMITTEE ON APPROPRIATIONS

Atty.

SorcoMw11279.

HUD-INDEPENDENT AGENCIES

Congress of the United States

DEPARTMENTS OF STATE, JUSTICE,

COMMERCE, THE JUDICIARY AND

Mouse of Representatibes

RELATED AGENCIES

Donau

Clashington, D.C. 20515

Ack

November 15, 1976

ASAP

11/24/76

WASHINGTON OFFICE:

336 CANNON HOUSE OFFICE BUILDING

WASHINGTON, D.C. 20515

(202) 225-7084

ENDELL M. HOLLOWA

MINISTRATIVE ASSISTAI

DISTRICT OFFICE

INGLEWOOD CITY HALI

1 MANCHESTER BOULEVARD

INGLEWOOD, CALIFORNIA 90301

(213) 678-5424

MARGUERITE J. ARCHIE

DISTRICT ADMINISTRATIVE ASSISTANT

Mr. Richard Sprague, Staff Director

Select Committee on Assassinations

Ind and D Streets, S. W.

House Annex #2 Room 3342

r. 1?

Dear Mr. Sprague:

May I recommend Laura Holt to serve as a member of the Select

Committee on Assassinations.

I have known Miss Holt throughout her educational and professional

career.

She is a highly qualified individual who will be able to

make a significant contribution as a member of the Select Com-

mittee.

Miss Holt brings to the position an excellent background in legal

research as a result of her legal

training and professional ex-

periences.

I sincerely hope that you will give ample consideration to her

application for a professional position with the Select Committee

Staff.

Yours sincerely,

YVONNE BRATHWAITE BURKE

MEMBER OF CONGRESS

NW 66000

Docld:32239451 Page 37

---

## Page 38

STANDARD FORM 171

PERSONAL QUALIFICATIONS STATEMENT

11. Kind of position (job) you are filing for for sisle of

B. Agnouncement No.

announcemens Legal or Semi-Legal

C. Options for which you wish to be considered (if listed in annunmoment) .

Office of Management and Budget

Approved 30-RO387

SELECT, COMMITTEE

D. Primary place (s) you wish to be employed

Anywhere in the D.C. area

2: Home phone (including Area Code)

30]

599-6349

3.

Othce

one including stea Coc

202\ 225-708

4. Name (Lass) (First)

(Middle)

and Address (Number, Street, Cily, State and ZIP i

• Stase and ZIP Codes Mr.

Holt, Laura Mae

2034 Taylor Run

Andrews AFB; Md: 2033}

• Appor.

• Nonappor.

Notations:

DO NOT WRITE IN THIS BLOCK

FOR USE OF EXAMINING OFFICE ONLY

Material

Entered Register:

I' Submitted

Returned

Form Reviewed:

Form Approved:

Opcion

Grade Earned

Rating

Preference

Aug:

Rating

§ point

Tens.,

710 Point

Comp. Di

S. Legal or voting residence (Stase)

California

6. Height without shoes

7. Weight

5 Fert _

7

-, Inches

140

8. Los Angeles e tornia

Los Angeles,

9. Birth date (Monsb, day, year)

September 24, 1940

10. So 5 9 28 1 50030

Numbes

11. If you have ever been employed by the Federal Govemment as a civilian, give your

last classification series, grade, and job title.

Other

10 Points

O Disi.

Initials and Date

Being

Investi-

gated

N.A

Dates of service in that grade

From

THIS SPACE FOR USE OF APPOINTING OFFICER UNLY

Preference has been verified through proof that the separation was

under honorable conditions, and other proof as required.

_ S-Pt.

10-Pr. Comp. Disab.

J 10-Pt. Other

To

Signature and Title

12. If you are currently on a list of eligibles for appointment to a Federal position, give

the name of the announcement, the haine of the office maintaining the list, the date

on your notice of rating, and your rating.

Agency

Date

Refer for medical action

N.A.

13. Lowest pay or grade you will accept

PAY

Is Open

per

OR

13. Will you accept temporary employment for:

(Acepiance or reposal of

_1 monch or less?

loporar employmeni will

not affech your consiciirarion —180 4 months?

for.odter.isppointments./

_4 to 12 months?

GRADE

14. When

will you be

available?

YES

*°

Immediately

16. Where will you accept a job?

_ Washington, D.C.

— Any place in the United Scates.

_Outside of the United States.

YES NO 17. Will you accept less than full tinge work?

(Less than 40 bouts per waek) | Yes

18. Are you willing to travel? (Check ine)

NO

SOME

LOFTEN

X.

Only in (specify):

19. VETERAN FREFERENCE. Answer all parts. If a part does not apply to you, answer "No.

A. Have you ever served on active dury in the United States military service? (Excludé sours of active duty for training as a reservise or Guardsman.)

B. Have you ever been discharged from the armed services under other than honorable conditions? (You may omit any such discharge changed

to honorable by a Discharge Review Board or similar authority.)..

If "Yes," give details in liem 37.

C. Do you claim 3-point preference based on active duty in the armed forces?.

If "Yes," you will be required to furnish records so suppors your claim at sbe time you are appointed.

D. Do you claim 10-point preference?..

If "Yes," check type of preference claimed and complese and altach Standard Form 1S. "Claim for 10-poins Veleran Preference,

Wife

with the proof called for

Widow

ilother

E. List Dates, Branch, and Serial or Service Number of All Active Service (Enter "N/A" if nor applicable)

From

To

N.A.

THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER

Branch of Service

Serial or Service Number

Page 1

Standard

Form 171

May. 1975 U.S. Civil Service Commission

171-105

NW 66000

Docld:32239451 Page 38

---

## Page 39

PLEASE BE SURE TO KEAD ATTACHED INSTRUCIIONS BEFONE COMMENCIG MEMS 20

20. EXPERIENCE (Start witk your PRESENT position and work tack scound fur periods of wrenslogans in sepurcia blocks in order.)

May inquiry be maile of your piesent employe: regarding your character, qualifiarions, and record of employmens?

(A "No" will ros affoir your consideration for employment upfortuniries exceps for HE RiNG EX,1MILiER positions. j

No

Dares uf employment (morib, gear)

Exact title of position

If Federal service, civilian oi railitary

From V (1971

To PRESENT TIME- 1976

LAWYER 1974-76

grade

Salary or earnings

Avg. hrs.

Place of en:ployment

Number and kind of einployees

Kind of business or organization

Starting $ 16,000

per year

per week

CityL. A.

supervised

(тапираститід, ассоміцілд, іпзиталс,

Present $ 25,

767 per

•year

50+

State: Calif.

None

8в6.)

Law Firm

Name of immediate supeivisor

Name of employer (frm, organization, eir.) and address (including ZIP Code, if kiosir:)

Rose Hemperley

Rose

Hemperley,

117 Swest

9th

Street

Area Code and phore No. ilkrown (213) 622-2075

Los Angeles, California 90015

Reason for wanting so leave I wish to move. East with my family.

Description of duties, iesponsitilities, and accumplishments

Private law firm pracgicing corporate, civil, domestic relations,

criminal, and tax law. Extensive research in the above areas as

well as writing briefs and memoranda. Making court appearances and

Jail vistts.

For agency use (skill codes, ésc.)

Dates of employment (minib, ya)

Exact title of position

If Federal service, civilian os military

From 1967

To 1968

Coordinator of Youth

grade

Salary or earning:

Starting $

per

Finals $12,00 kr

year

Avg. hrs.

per week

40

Place of employment

Number and kind of employees

supervised

Kind ofbusiness or oiganization

CityL.A..

(inalifacturing, accounting, insuranie,

Starfalif.

None

« Community Mental

Name of immediate supervisor

Name of employer (fam, organization, etc.) and address (hat, ela corean ey

Horace Austin

Central

City Community Mental Health

Area Code and phore No. if kriown (2131 232-4111

4211 South Avalon Blvd. L.A. 90011

Reason for leaving

Left to attend Law School full time from 1968-1971.

Description of duties, responsibilities, and accomplishments

Evaluated and recommended workable solutions to juvenile problems on

an individual and group basis. Served as laison and coordinated

with outside agencies. Attended juvenile court hearings.

For agency use (skill cries, esc.)

Dates of er-ploynent (montb, year)

From 1966

то 1967

Salary or earnings

Starring $

Final $ 10,000

per

per

year

Avg. hrs.

pet week

40+

Basic Skills Instructor F

if federal service, civilian •i railitary

Basic

N.A.

Place of employment

Number and kind of employees

Kind of business or osbalization

CityL.A.

supervised

(maNufacturing, accounting, insurance,

SacCalif.

None

8. Youth Training&

Vame of immedite superviso

John Smith

raining G

Ares Code and phone No. ilknown 213), 757-8771

79027 South Figueroa L. A. 90003

Rezson for leaving

Accepted a better paying job with greater potential to advance.

Description of duties, responsibilities, and accomplishments

Taught basic english, writing and math to high school drop-outs between

the ages of 16 and 21.

1965 Full time employee at Ventura School for Girls. 3100 Wright Rd.

Camarillo, Calif.

Fall of 1963-65 Fall time graduate student

1960-63 full time college student

For agency use (skill codes, etc.)

1956-59 High School student

NW 66000 p,

Docld:32239451 Page 39

IF YOU NEED ADDITIONAL EXPERIENCE BLOCKS USE STANDARD FORM 171-A OR BLANK SHEETS

SEE INSTRUCTION SHEET

---

## Page 40

ATTACH SUPPLEMENTAL SHEETS OR FORMS HERE

• ANSWER ALL QUESTIONS CORRECTLY AND FULLY

21 A. Special qualifications and skills (skills with machines; parents or inventions; your inoss imporiars piblications (do not submit copies tailess requessed); juar pebli

peaking end publications experience; membership in professional or scientific societies; esc.)

Member, Pennsylvania Bar

3. Kind of License or Certificate (For example, pilor

egilened nurse, lawyer, radio opeto, C. P.A., etc.,

Lawyer

C. State or other licensing authority

Pennsylvania

D. Year of first

license

194 fincate

E. Year of latest

license

• Approximate numbe

of words per minute

4Tng

Thorthand

41

22. A. Did you graduate from high school, or will

B. Name and location (city and Stale) of last high schosl attended

you graduate within the next nine months?

HIC EST GRADE DUMPLETED

Dorsey High School, Los Angeles, Calif.

C. Nartie and location (dily, Stale, and ZIP Code if krown) of college

Dates attended

Years Completed

No. of credits compl.

or university. (If you expect so graduate within 9 monibs, give

Semester

Quarter

MONTH and year you expere degree.)

From

To

Day

Night

hours

hours

LegICe

V B.A., etc.

Cal State University at L.A.

and L. A. Pacific College

1960

1963

4

124

Year of

degree

D. Chief undergraduate college subjects

Sociology & Poli Sei

No. of credits compl.

Semester

Quarter

hours

hours

35

E. Chief graduate college subjects

B.A.

1963

No. of credits compl.

Semester

hours

Quarter

hours

Law J.D. 1971

180+

Epapatelew Consumer Law, Constitutional Law, Minority Business

G. Other schools or training (for example, trade, vocational, arrned forces, or business). Give for each the name and location (city, Stale, and ZIP Code if known) of

school, dares attended, subjects studied, numbir of classroom hours of instruction per week, certificates, and any other pertinent data.

Boalt Hall School of Law

University of California at Berkeley

Berkeley, California 94620

23. HONORS, AWARDS, AND FELLOWSHIPS

RECEIVED

Martin Luther King, JI.

Fellow.

24. LANGUAGES OTHER THAN ENGLISH

List the languages and indicate

your knowledge of each by

parine et proper columns

Boalt Hall School of Law

Board Member Eastside Settlement House

Reading

Speaking

Understanding

Excl Good jair Excl Good Fair Excl Good,

Writing

iS. REFERENCES. List three persons who are NOT related so you and who have definite knowledge of your qualifications and fitness for the position for which

you are applying.

Do not repeat names of supervisors listed under Item 20, EXPERIENCE

PRESENT BUSINESS OR HOME ADDRESS

FULL NAME

(Number, Street, City, State and ZIP Code)

BUSINESS OR OCCUPATION

-6706 Lincoln Drive

Merle Hughes

Philadelphia, Pa. 19119

Lawyer

Western Savings Bank Bldg.

Ron Merriweather

Suite 911 Btoad & Chestnut St.

Phila. Pa. 19107

Katherine Tooks

3087 Manning Ave. L. A: 90064

Lawyer

Lawyer

Page 3

NW 66000

Docld:32239451 Page 40

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## Page 41

ANSWER ITEMS 26 THROUGH 36 BY PLACING AN "X" IN THE PROPER COLUMN

26.

Are you a citizen of the United States?

If "No."

give country di which you are a cirizen:

Before answering tbese questions read llems 27 and 28 in the alached instructions.

27. Are you now a member of the Communist Parry, U.S.A., or any subdivision of the Communist Parry, U.S.A.?...

28. (a) Are you now,

or within the last ten years have you been, a member of any organization, or group of persons including but nor limited

o the Communist Party, U.S.A., or any subdivision of the Communist Party, U.S.A., which during the period of your membership you knew

was advocating or teaching. that the government of the United States or any political subdivision thereof should be overthrown or overturned by

force, violence,

of any unlawful means?.

28. (b) If your answer to (a) is in the affirmative, did you, during the period of such membership, have the specific intent to further the aims of

such organization or group of persons to overthrow or overturn the government of the United States or any stare or any political subdivision

thereof by force, violence, or any unlawful means?..

29.

If your answer to 27 or 28(a) above is in the affirmative state the names of such organizations and the dates of your membership in each in

item 37.

30.

Within the last five years have you been fired from any job for any reason?..

31.

Within the last five years have you quit a job after being notified that you would be fred?

If your answer lu 30 or 31 above is "Yes," give desails in liem 37. Show the name and address (including ZIP Code) of employer, approximase dale, and

• reasons in each case. This information should agree wish your answers in liem 20, EXPERIENCE.

32. Have you ever been convicted of an offense against the law or forfeited collateral, or are you now under charges for any offense against the law?

(You may omit: (1) traffic violations for which you paid a fine of $30.00 or less; and (2) any offense committed before your 2 ist birthday which

was finally adjudicared in a juvenile court or under a Youth Offender law.) ..

33. While in the military service were you ever convicted by general court-martial?

If your answer to 32 08.33 is "'Yes," give desails in liem 37. Show for each offense: (1) dale; (2) charge; (3) place; (4) COuTs; and (S) action saken.

Yes

No

X

X

X

34. Does the United Stares Government employ in a civilian capacity or as a member of the Armed Forces any relative of yours (by blood or marriage)?

(See Items 34 and 35 in the attached instruction sheet.) ...

35. Do you live with, or within the past 12 months have you lived with, any of these relatives who are employed in a civilian capacity?.

mens, agency, or branch of she Armed Forces. If your ansuer so 35 is!

lived with within the past 12 months.

36. Do you receive or do you have a pending application for retirement or retainer pay, pension, or other compensation based upon military, Federal

civilian, or District of Columbia Government service?..

Y your ansuer is "Yes," give desails in liem 37.

Your Statement cannos be processed until you bave answered all questions, including liems 26 through 36 above. Be sure you have placed an "X"' to she lefi of EVERY

marker (4) above, either in the "Yes" or the "No'' column.

37. Space for detailed answers. Indicate Item number to which answers apply.

Item No.

34

Kenneth Michael Binion, Nephew

4409 S. Harvard

LOS

Angeles, Ca. 90062

U.S. Marines

If more space is required, use full sheets of paper approximately the same size as this page. Write on EACH sheet your name, birth date. and announcement or

position title. Attach all sheets to this Statement, at the top of Page 3.

ATTENTION - THIS STATEMENT MUST BE SIGNED

Read the following paragraph carefully before signing this-Statement

A falso answer to any question in this Statoniant may bo grounds for not employing you, or for dismissing you after you begin

work, sind may be punishable by fine or Imprisonment (U.S. Codo, Mille 18, Soc. 1001). All statements are subject to investigation,

including a chait of your Angorprints, police rocords, and formor employars. All she information you glve will bo considered in

reviewing your statamons and is subjost to investigation. A false answer to loms 27 or 28 could deprive you of your right so on

annuity when you resch retirertant oge in addition to the penalties described abovo.

CERTIFICATION

SIGNATURE (Sign in ink)

DATE SIGNED

I CERTIFY that all of the statements made in this Statement

are true, complete, and correct to the best"of my knowledge

and belief, and are made in good faith.

NVU bb001

Docld:32239451 Page 41

9-29 - 76

+48-16-81181-2

474-401

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## Page 42

How sif

21 A

2034. Taylor Run

Andrews AFB, Ma. 20331

(301)

599-6349

10-4

Ack

MOLT

HOLT

173% Hesi Adanis Boulerad

Los Angeles, California 90018

Telephones: (413) 735-6348-01

(213) 734-4951

EDUCATION

MEMBERSIIP

Boalt Hall School of Law, University of California, Berkcley

J. D. Degree - 1971

Los Angeles Pacific College - Los Angeles, California

B. A. Degree - 1963.

Major: Sociology

Minor: Political Science

Member, Pennsylvania Dar Association

PROFESSIONAL EXPERIENCE

1971 - 1975

Rose Hemperley, Attorney at Law

117 1: 9th St., Los Angeles, Calif.

Telephone: (213) 622-2075

LAW CLERK

Private firm practicing corporale, civil, domestic relations, criminal, and tax law.

1970 - 1971

White and Cruickshank

Altorneys at Law

Oakland, California

RESEAKCH ASSISTANT (part-time)

Served as Research Assistant to Mr. Clinton White in this firm practicing criminal

law. Some exposure to trial work. Aiso, Assistant Editor/Research Assistant to

Professor Robert M. O'Neil at Boalt, during this period.

1967 - 1968

Central City Community Mental

Health Center, Los Angeles, Calif

COORDINATOR of Youth Activities

Evaluated, and recommended workable solutions to juvenile problems, on both an

individual and a group basis. Sered as liaison and courdinated with outside agencies,

such as Police Department and Sheriff's Oifice. Allended juvchile court hearings.

Participated in formuiating and inplementing programs.

1966 - 1967

Youth Training & Employment

Project, Los Angcles, Calif.

NW 66000

Docld:32239451 Page 42

INSTHUCTOR in Basic Skills

Taught basic Logish, writing and mathematics to school dropouts betcen 16 and

21. Counseled, rested and graded, and provided assistanes on specific problems.

Was sucressful in persuading a significant number of my students to return to

formal schooling

... both acadenie and trade.

---

## Page 43

LAURA MAE HOLT

lage Two

PROFESSIONAL EXPERIENCE (Continued)

1965 - 196

Ventura School for Girls

Camarillo, California

GROUP SUPERVISOR

Evalu ed girls, cunposed behavior and progress reports. participated in group

counseling, set up and supervised programs, and dirceted all recreational actisities

for a group of 50 delinquent giris under the jurisdiction of the Youth Authority.

1963, 1964, & 965

Eastside Settlement - House

Los Angeles, California

COUNSELOR/INSTRUCTOR (summers and part-ume)

Initiated a math tutoring proyam. "Assisted in obtaining employment, job

development and training programs, and recreational actistics. "Sought to

subtly möld "and change the idcas and beliefs of juveniles, speufically regard-

ing the need for education, and the ability to accept responsibility and put

forth self improvement. Also, presently a member of the Board of Directors.

PERSONAL DATA

REFERENCES

Native Californian, born September, 1940. Single, Health excellent. Willing to

travel, and to relocate. U. S. Citizer.

Bondable.

Professor Lawrence Sullivan

Boalt Hall School of Law

University of California at Berkeley

Berkeley, California 94620

: (415) 642-2273

Mr. Henry A. Talbert

National Urban League, Inc.

Director, Western Regional Office

4055 Wishire Boulevard, Suite 526

Los Angeles, California 90010

(213) 381-5643

Dr. Gail Wyatt

UCLA Ncuro-Psychialnic Institute

- 750 Westwood Plaza

Los Angeles, California 90027

(213) 825-0193

NW 66000

Docld:32239451 Page 43

---

## Page 44

STANDARD FORM 171

PERSONAL QUALIFICATIONS STATEMENT

lá. Find of posicion (job) you are fling for for tiste of:

uncement No.

annunemen Legal or Semi-Legal

Opuons for which you wish to be considered (if listed in arn

Sub-committee on Assassinations

D. Primary place,

Anywhere in the D.C. area

пррог.

Nonappor.

Notations:

2. Home phone (inciuding Area Code)

30]

599-6349

Office

none includine area Code

2021:225-708

4. Name (Lass) (First)..: (Middle)

and Address (Number, SiMi, diy, Sal den, 1P CodeS Mr.

] Miss:

# Mrs.

Form Reviewed:

Form Approved:

•Option

Holt, Laura Mae

2034 Taylor Run

Andrews AFB; Md

2033}

Office of Management and Buds

Approved 5D-R0387

DO NOT WRITE IN THIS BLOCK

FOR USE OF EXAMINING OFPICE ONLY

Material

Entered Register:

• Submitted

Returned

Grade

Earned

Rating®

•Preference

Aug

Rating

ANNOUNCEMENT

• points

•Teni.)

Legal of voting residence (Stase)

California

6. Height without shoes

7. Weight

5 Feet _

"140

→ Inches

sos Angeles catfornia

9. September 24, 1940

10. 5559428-503Numbe

" Lay chancion see pore od ide federal Govemen era civian, give you,

10 Points

• Comp. Dis.

Other

10 Points

_ Disal.

Initials and Date

Being

Investi-

gated

STATEMENT NU

¿ THIS SPACE FOR USE OF APPOINTING OFFICER ONLY

+ Preference has been verified through proof that the separation wa

under honorable conditions, and other; proof as required

Dates of service in that grade

From

10-Pe. Other..

To

Signature and Title

12. I you are, currently on a list of eligibles for appointment to a Federal position, give

the name of the announcement, the name of the offce maintaining the list, the dare

on your notice of rating; and your rating.

Agency

Date

Refer for medical action

N.A.

13. Lowest pay or grade you will accept

PAY

s Open

per

OR

1S. Will you accept remporary employment for:

(Acieplance or refusal of...

_1 month of less?

semporary employment will.

not affect your considination

_1 to 4 months?

for.otkerappointmenss./.i

_4 to 12 months?

10030

14. When will you be

available?

GRADE:

Immediately

YES NO

16. Where will you accept a job?

Washington, D.C.

_¿Any place in the United States.

_Ourside of the United States.

z:Only.in (sperify):CaI.C1

YES NO

17. Will you accepr less than full finge work?

(Less than 40 bours per week). Yes! No

18. Are you willing to travel? (Cbock one).

NO

SOME

OFTEN

02Q21

19.

VETERAN PREFERENCE. Answer all parts. If a part does not apply.to you, answer

MOLE 41

192107

A. Have you ever served on active duty in the United States military service? (Excludé sours of active duty for training as a

reserviss or Guardsman.).

3. to honor die by Discharge love to are envie paler vier dad honorable condition? (You may on any nich dictave changed

"If"Yes," give desails in Isem 37.

Do you claim s-point preference based on active duty in the armed forces?

If "'Yes," you will be required to furnish records so support your claim at she time you are appointed.

Do you claim 10 point preference?:, d

If "Yes," check tipe of preference claimed and complese and astach Standard Form 13.

TYPE: Compensable disability

D Disability

Preference

• Wife

X

etber with tbe proof called for.

# Widow

I Mocher:

E. List Dates, Branch, and Serial or Service Number óf All Active Service: (Enter "N/A' if nos applicable)

From

- To

Branch of Service

Serial of Service Number

N.A.

THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER

Page 1

Standard Form :171

* May. 1975 U.S. Civil Service Commission

171-105

NW 66000

Docld:32239451 Page 44

---

## Page 45

PLEASE BE SURE TO READ ATTACHED INSTRUCTIONS BEFORE COMPLETING ITEM 20

20: EXPERIENCE (Siar wist your PRESENT position and work back: Moount for periods of unemployens in separasa blocks in order:)in

May inquiry be made of your present employer regarding your character, qualifications, and record of empioyment?:

(1 "No" will sos affos your consideration for employment opportunities except for. HEARING EXAMINER positions:)

del Yes

If Federal service, civilian or military

No

Dares of employment (monto, jeer).

Exact title of position

т.

197]

To PRESENT TIME1 97 6

Law Clerk

grade.

Salary or earnings

Avg. hrs.

Place of employment.

Number and kind of employees

Kind of business or organization

Seating $ 16, 000

per

year

per week

supervised

(manufacturing, ACCOuNtSIE, InsuTance,

Presint s 25, 767 per

50+

State: Calif.

None

c) Law Firm

Name of employer (firm, organization, eic.) and address (including ZIP Code, if krowur)

Rose Hemperley

Rose Hemperley,

117 Swest 9th Street

Area Code and phore No: if known (213). 622-2075

Los Angeles,

• California 90015

Reason for wanting roleve I wish to move. East with my family.

Description of duties, responsibilities, and accomplishments

Private law firm pracgicing corporate, civil, domestic relations,

criminal, and tax law. Extensive research in the above areas as

well as writing briefs and memoranda. Making court appearances and

Jali visits.

, en

For agency use (skill codes, esc.)

Dates of employment (montb; year):

Exact title of position

If Federal service, civilian or military

From 1967

To 1968

Coordinator of Youth

grade sai

Salary or earning!

Avg. hrs.

Place of employment

Number and kind of employees

Kind abusiness or organization

(manufacturing, accounting, insuranie,

Starting 8.

CiryL.A.

Finals $12,00 Oper

StareCalif.

«s.) Community Mental

Name of immediate supervisor

Name of employer (firm, organization, ac.) and address (WhEn En colet s5

Horace. Austin

Central City Community Mental Health

Area Code and phore No. if krown (213% 232-4111

4211 South Avalon Blvd.- L.A. 90011

Reason for leaving

Left to attend Law School full time from 1968-1971.

Description of dutics, responsibilities, and accomplishments

Evaluated and

recommended workable sotutions to juvenile problems on

an individual and group basis:

Served as laison and coordinated

with outside agencies. Attended juvenile court hearings.

For agency use (skill coes, esc.)

Dates of employment (mozib, year)

From 1966

To 1967

Baste Skills Instructorse

Basic

i Rederal service, civilian or military

Kind of business or organizatich

Salary or carnings.

Scarring $

Final $ 10,000

per

per.

year

Avg. hrs.

per wreck

40+

Place of employment.

Number and kind of empioyees

City L.A.

supervised.:

scareCalif

None

8. Youth Training&

Name of immediate

Name of empicyer (firm, organization, ac.) and address (inally 29ye her To Jec

John

Smith sor

Youth

Training & Employment Project

Ares Code and phone No. ifknown( 213), 757-87.71

9027 South Figueroa L. A. 90003

Accepted a better paying job with greater potential to advance.

description of duties, responsibilities, and accomplishment

raught basic english, writing, and math to high school, arop-outs betwee

the ages of 16 and 21.

1965 Full time employee at Ventura School for Girls. 3100 Wright Rd.

Camarillo, Calif.

Fall of 1963-65 Fall time graduate student

1960-03. full time college student

For agency use (shill rodes, esc.)

1956-59 High School student

IF YOU NEED ADDITIONAL EXPERIENCE BLOCKS USE STANDARD FORM 171-A OR BLANK SHEETS

SEE INSTRUCTION SHEET

Page 1

NW 66000

"Docld:32239451 Page 45

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## Page 46

ATTACH SUPPLEMENTAL SHEETS OR FORMS HERE

• ANSWER ALL QUESTIONS CORRECTLY AND FULLY

A. Special gualifications and stils /shith sib matrines, posrus or camarions; your mos importent prolicaiions (do nor suben copres acless exqueseal, juas aski

speaking end publicaiions experimiz; membersbip in professional or scintific soricties; esc.)

Member,

Pennsylvania Bar

3. Kind of License or Certifcar (For example, pilos,

registered nurse, lawyer, radio operator, C.P.A., esc.)

Lawyer

C. State or other licensing authoricy

Pennsylvania

D.

Year of first

license

197 grificate

E.".Y ear of latest.

license

F. Approximate nur

of words per min

47ng

Shorth

41

22. A.

Did you graduate from high school, or will

you graduate within the next nine months?

Jan: 1159

NO

FIC SS'T GRADE COMPLSTED

C. Nare and location (city, Stars, and ZIP Code if known) of college

university. (If you expecs do graducie within 9 monibs, give

MONTH and year you expert degree..)

Cal State University at L.A

and L. A. Pacific College

B.

Name and location (city and Sicie) of last high school attended

Dorsey High

school,

LOS

Dates attended

Years Complered:

From

: To

Dậy

Night

Angeles,

No: of credits compl.

Semester.

quarter

hours

Bours

Calif.

Type o1:

degree y

(в.Л., ex.

de

1960

1963

4

124

D. Chief undergraduate college subjects 312 C

Sociology & Poli ScI

No. of credits compl.

Semester,

hours

hours

35

E. Chief graduate college subjects

B.A.

19

No. of credits o

Semester

hours

Law J.D. 1971

180+

eir feld send highest leo mea

corpotate

Law, Constitutional Law, Minority Business

G. Other schools or training (for example, trade, vocational, armed forces, or busmess). Give for each the name and location (city, State, and ZIP Code if known,

school, dates attended, subjects studied, number of classroom hours of instruction per week, certificates, and any other pertinent data.

Boalt Hall

School-of Law

University of California at Berkeley

Berkeley, California 94620

23. HONORS, AWARDS, AND FELLOWSHIPS

RECEIVED

Martin Luther King, JI.

Fellow.

24. LANGUAGES OTHER THAN ENGLISH

List the languages and indicate

your knowledge of each by

plaine nei proper columns

Boalt Hall School of Law

Board Member Eastside Settlement House

Reading

Speaking

Understanding

Wr

Excl Good Fair

Excl Good Fair Excl Good Fair ExciG

X

25. REFERENCES: List three persons who are NOT related to you and who have definite knowledge of your qualifcations and fitness for the position for a

you are applying. Do nos repeat names of superyisors listed under Item 20, EXPERIENCE.

PRESENT BUSINESS OR HOME ADDRESS

BUSINESS OR OCCUP

FULL NAME

(Number, Street, City, State and ZIP Code)

6706 Lincoln DrIVe

Merle Hughes

- Ron Merriweather

Philadelphia, Pa. 19119

Lawyer

Western Savings Bank Bidg.

Suite 911 Broad & Chestnut St.

Phila. Pa. 19107

Katherine Tooks

3087 Manning Ave. L. A. 90064

Lawyer.

Lawyer

Page 3

NW 66000

Docld:32239451

Page 46

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## Page 47

26.

ANSWER ITEMS 26 THROUGH 36 BY PLACING AN

"X"

IN THE PROPER COLUMN

Are you a citizen of the United States?.

If 'No,

give country of which you are a cirizen:

27.

Before answering ibese questions read liems 27 and 28 in the alached instractions.

Are you now a membes of the Communist Parry, U.S.A., us any subdivision of the Communist Parry. U.S.A.?.

28.

(a) Are you now, or within the last ren years have you been, a member of any organization, or group of persons including but not limiced

to the Communist Party, U.S.A., of any subdivision of the Communist Parry, U.S.A., which during the period of your membership you knew

was advocating or reaching that the government of the United Stares or any political subdivision thereof should be overthrown or overturned by

force, violence, or any unlawful means?.

N

X

such organization. or group of persons to overthrow or overturn the government of the

thereof by force, violence, or any unlawful means?.

29. If your answer to 27 or 28(a) above is in the affirmative state the names of such organizations and the dates of your membership in each in

• Item 37..

30. Within the last five years have you been fired from any job for any reason?

31.. Within the last five years have you quit a job after being notified thar you would be fred?

• If your answer 10 30 or 31 above is

"Yes,

give details in liem 37. Show the name and address (including ZIP Code) of empioyer, approximale dait, and

•reasons in eact case. This information should agree with your answers in llem 20, EXPERIENCE.

32.

Have you ever been convicted of an offense against the law or forfeited collateral, or are you nor under charges for any offense against the law?

(You may omit: (1) traffic violations for which you paid a fne of $30.00 or less; and (2) any ofense committed before your "2.lst birthday which

was hnally adjudicated in a juvenile court or under a Youth Offender, law.)

33. While in the military service were you ever convicted by general court-martial?..

''S your answer to 32 oR 33 is "Yes." giüe desails in liem 37. Show for each ofense: (1) date, (2) charge; (3) place: (4) cuTt, and (S) action taken.

X

X

X

X

34. "Does the United States Government employ in a civilian capacity or as a member of the Armed Forces any selative of yours (by blood or marriage)?

(See Items 34 and 39 in the attached instruction sheer.) ...

35. Do you live with, or within the past 12 months have you lived with.

'If your answuer'so'34 is "Yes,"' give. in Item 37 for such relatives: (1) full name; (2) present address (including ZIP Code); (3) relationship; (4) depa

mens, agency, or branch of ibe Armed forces. " your ansuer so. 35 is "'Yes,", also give she kind of appoiniment beld by the relatives) you live with of

'lived with wishin ibe past 12 monshs.

X

36. Do you receive or do you have a pending application for retirement or retainer pay, pension, or other compensation based upon military, Federal

civilian, or District of Columbia Government service? : ...

If your answer is "'Yes,"' give desails in liem 37.

Your Statement connor be processed until you bave answered all questions, including lems 26 tbrough 36 above. Be sure you have placed an ''X"' to the lejs of EVER

marker. 18) above, either in the "Yes" or ibe "No": column..

37. Space for detailed answers. Indicate Item number to which answers apply.

Item No.

34

Kenneth Michael Binion, Nephew

4409 S. Harvard -C

Los Angeles,

Ca. 90062

U.S. Marines

•C7OC74/01

more space is required, use full sheets of paper approximately the same size as this page. Write on EACH sheet your name, birth date. and announcement i

sition title. Attach all sheets to this Statement at the-top of Page

ATTENTION - THIS STATEMENT MUST BE SIGNED

Read the following paragraph corefully before signing this-Statement

A false answer to any question in this Statemens may ho grounds for nos omploying you, or for dismissing you after you bog

work, and may be punishable by fine or imprisonment (U.S, Codo, Milo 18, Soc.

1001). All statemonts are subioct do Investigatie

induding a chack of your Angerprints, police records, and former employers. All the Information you give will bo consiscred

reviewing your Statemens and is subjost to investigation. A faise answer to Items 27 or 28 could deprive you of your right te,

annuity when you reach refiremant oge in addition to the penalties described above.

CERTIFICATION

SIGNATURE (Sign in ink)

DATE SIGNED

I CERTIFY that all of the statements made in this Statement

are true, complete, and correct to the best of my knowledge

and belief, ard are made in good faith.

Lave the tilt

Page 4

aPo

9 - 29-76

+48-18-81184-2

NW 66000

Docld:32239451 Page 47

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