Originator: HSCA
Document date: 1978-05-15 00:00:00
Document type: PRINTED FORM

# DOCID-32239456

## Page 1

Date: 08/20/93

Page: 1

JFK ASSASSINATION SYSTEM

IDENTIFICATION FORM

AGENCY INFORMATION

AGENCY : HSCA

RECORD NUMBER: 180-10060-10448

RECORDS SERIES :

STAFF PARYOLL RECORDS

AGENCY FILE NUMBER :

DOCUMENT INFORMATION

ORIGINATOR : HSCA

FROM :

то :

TITLE :

Released under the John F. Kennedy

Assassination Records Collection Act of

1992(44 USC 2107 Note]. Case#N'w

SENT Date: 11-04-2021

DATE: 05/15/7

PAGES : 4

SUBJECTS:

HSCA, ADMINISTRATION

JACKSON, BEVERLY

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:32239456 Page 1

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## Page 2

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)

Beverly Jackson

Employee Social Security Number

577-75-1080

Employing Office or Committee/Subcommittee

Assassinations

Effective Date

32/31/78

Type of Action

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

Position Title

• Appointment

• Salary Adjustment

I Title Change

¿ Termination (At close of business on effective date)

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

close of business_...

Specify Date

Gross Annual Salary*

* If employee is a civil service annuitant (includes US House of Representatives), the gross annual salary shown should include the annuity received by the employee

plus the salary received from the employing office

(If Committee Employee, complete appropriate item below)

1.0

Standing Committee: Staff— Clerical or • Professional.

2. il Special (Investigative staff of Standing Committee) or Select Committee: Authority-H. Res. 956_of95th Congress.

3. I 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.SC 3110(b), prohibiting the employment of

relatives.

Date_-

January

2

1979

Ilf appropriate, signature of Subcommittee Chairman or Ranking Minority Member)

-(Signature of Aurhorizing Officiall

LOUTA STONES

(Type or print nome 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 S.

Chairman, Committee on House Administration

ID

Benefits

Payroll -

00 as of

Copy for Initiating Office or Committee

(Revised August 1, 1977)

-

NW 66000 Docld:32239456 Page 2

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## Page 3

PAYROLL AUTHORIZATION FORM

(Please Use Typewriter

or Ballpoint Pen)

U.S. HOUSE OF REPRESENTATIVES

Washington, D.C. 20515

authorizing official

To the Clerk of the House of Representatives:

I hereby authorize the following payroll action:

Employee Name (First-Middle-Last)

-Beverly Jackson

Employee Social Security Number

Effective Date

5/15/78

Type of Action

577-76-1080

Employing Office or Committee/Subcommittee

Assassinations

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

Position Title

* Appontment

• Salary Adjustment

O Title Change

• Termination (At close of business on effective date)

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

close of business._..

"Specily Date"

Gross Annual Salary*

$13,500

Secretary

* If employee is a civil service annuitant (includes U S. House of Representatives), the gross annual salary shown should include the annuity received by the employee

plus the salary received from the employing office.

(If Committee Employee, complete appropriate item below)

1. • Standing Committee: Staff— Clerical or • Professional.

2. ' Special (Investigative staff of Standing Committee) or Select Committee: Authority—H. Res. 956

_of 200 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 US.C 3110(b), prohibiting the employment of

relatives.

5/15/78

Date.

19.

in -

(if appropriate, signature of Subcommittee Chairman or Ranking Minority Member)

LOUIS STURES ONE-On

(Type or print name of Authorizing Official)

(Type or print name and title of above official)

(Title - If Member, District and State)

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

ployees, except those of the Committee on Appropriations, the Committee on the Budget, and the Joint Committees, 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.

ID

Benefits

Payroll.

00 as of

Copy for Initiating Office or Committee

(Revised August 1, 1977)

NW 66000 Docld:32239456 Page 3

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## Page 4

MEMORANDUM

TO :

Tom Howarth, Budget Officer

Elizabeth Berning, Chief Clerk

FROM: I. Charles Mathews, Special Counsel V. C. M.

DATE: May 4, 1978

RE: Ms. Beverly Jackson

Please be advised that effective Monday, May 15,

1978, Ms. Beverly Jackson has accepted the position of

secretary with the Martin Luther King Task Force. Her

effective starting salary will be $13,500.00

If you have any questions concerning this matter,

please contact me at your convenience.

ICM: j

NW 66000 Docld:32239456 Page 4

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## Page 5

MEMORANDUM

TO: ALL STAFF

RE: Payroll Certification

The Regulations and Accounting Procedures for Allowances and

Expenses of Committees,

Representatives require that, among other things, the Committee's

monthly payroll certification include the relationship, if any, of

each employee to any current Member of Congress.

This certification

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

Please complete the appropriate portion below, sign and date

this form, which will then become a part of your permanent personnel

file.

If this status changes, you must notify the Committee's Budget

Office immediately of the change.

I am not related to any current (95th Congress) Member of Congress.

I am related to a current (95th Congress) Member of Congress.

(Please specify.)

Duels A. Actson

Signature of/Employee

5/2/78

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