## Page 1

AGENCY

RECORD

NUMBER

RECORD

SERIES

AGENCY FILE NUMBER

Assassination Records Review Board

Final Determination Notification

: HSCA

: 180-10060-10468

: STAFF

PAYROLL RECORDS

December 8, 1995

Status of Document:

Postponed in Part

Number of releases of previously postponed information: 14

Reason for Board Action: The Review Board's decision was premised on several factors

including: (a) the significant historical interest in the document in question; (b) the

absence of evidence that the release of the information would cause harm to the United

States or to any individual.

Number of Postponements: 10

Postponements: All the postponements in this document represent Social Security numbers.

Reason for Board Action: The text is redacted because the public disclosure of the redaction could

reasonably be expected to constitute an unwarranted invasion of personal privacy, and that invasion of

privacy would be so substantial that it outweighs the public interest.

Substitute Language: SSN

Date of Next Review: 2017

Board Review Completed: 10/24/95

Aeleased under the John F.

ROSEt: Nw 88326 Date:

NW 88326

Docld:32239476 Page 1

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## Page 2

• 12

Date: 08/20/93

Page: 1

JFK ASSASSINATION SYSTEM

IDENTIFICATION FORM

AGENCY INFORMATION

AGENCY : HSCA

RECORD NUMBER: 180-10060-10468

RECORDS SERIES :

STAFF PAYROLL RECORDS

AGENCY FILE NUMBER :

DOCUMENT INFORMATION

ORIGINATOR : SCA

FROM :

TITLE :

DATE: 12/06/76

PAGES : 16

SUBJECTS :

HSCA, ADMINISTRATION

LEHNER, ROBERT

DOCUMENT TYPE : PRINTED FORM

CLASSIFICATION : U

RESTRICTIONS : 3

CURRENT STATUS : P

DATE OF LAST REVIEW : 06/04/93

OPENING CRITERIA :

COMMENTS :

вох 2.

[R] - ITEM IS RESTRICTED

NW 88326

Docld:32239476 Page 2

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## Page 3

C

LEHNER, Robert

Nime of Employce

Addreas

AJuross

Phone Number

Position Tilla

Pasmoil Number

Benth

I2TI

Jon.

reb.

Mar.

Apr.

May.

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

= 0.5 day annual leavo

= 1.0 day annual leavo

= 0,5 day sick leave

= 1.0 day sicx leavo

=

0.5 day administrative leavo

= 1.0 day administralive leava

= 0.5 day unauthorized absenco

= 1.0 day unaulhorized absenco

= 0.5 day leave without pay.

= 1.0 doy leave without pay

NW 88326

Docld:32239476 Page 3

Step

DAY

14

OFFICE OF THE CLERX

U.S. HOUSE OF REPRESENTATIVES

PERSONAL LEAVE RECORD

1978

YEAR

DATE OF APPOINTMENT

12-6-76

PRIOR FEDERAL SERVICE

ANNUAL LEAVE

CATEGORY

1.0

1,5

2,0

ACCRUED

THIS MONTH

OF MONTH

10717 18 19/20 31 22 23 211

25 201

27

29

301

AVAILAOLE

THIS MONTH

Sick

13

14

UST.O

TIIS WONTH

Annual

Leave

7

Sick

Leave

BALANCE BROUGHT

FORWARO

FRO!S

PRECEDING

YEAR

Annual

Leave

sick

Leare

12

13

BALANCE

AT

CLOSE

OF MONIK

Annual

Leave

SUPLOYIE

INITIALS

Sick

Leave

14

Tormuriatel 2/18/18140 orien

Mlude & la

wind beare and

Employed's Signatura

Dutc

111 employee reluses to sign, state reason below."

Chial's Signature

Approved:

Cleris of the Houso

Dato

This record will be forwarded to the Clerk of the House at the end of each calendar year, or in case of termination, alons

with the reguest for termination. Upon approval, the record will be filed in the omployec's oflicial personnel folde:

EXHIBILI

---

## Page 4

LOUIS STOKES, OHIO, CHAIRMAN

RICHARDSON PREYER, N.C.

SAMUEL L DEVINE, OHIO

WALTER E. FAUNTROY, D.G.

STEWART B. MC KINNEY, CONN.

YVONNE BRATHWAITE BURKE, CALIF. :

CHARLES THONE, NEOR

HAROLD S. SAWYER, MICH.

MAROLD E: FORD, TENN.

FLOYD J. FITHIAN, IND.

ROBERT W. EDGAR, PA.

:: (202) 225-4624

Select Committee on Assassinations

H.*. House of Representatives

3338 HOUSE OFFICE BUILDING, ANNEX?

WASHINGTON, D.C: 20515

September 19, 1978

U. S. Department of Justice

Personnel Room 6248

10th & Pennsylvania Avenue, N. W.

Washington, D. C. 20530

Personnel Office:

Attention: Susan Reneer

In resonse to your telephone inquiry, we are verifying the

following information on Robert J. Lehner.

Appointed:

December 6, 1976

Teminated:

February 28, 1978

Salary:

$45,500.00

sincerely yours,

THOMAS HOWARTH

Budget Officer

TH: ht

NW 88326

Docld:32239476 Page 4

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## Page 5

PAYROLL AUTHORIZATION FO

(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)

Robere J. Lehner®

Employee Social Security Number

071-28-5111

Employing Office or Committee/Subcommittee

Select Committee on Assassinations

Effective Date

February 28, 1978

Type of Action

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

Position Title

• Appointment

• Salary Adjustment

• Title Change

*Termination (Ar 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 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.)

10

Standing Committee: Staff—D Clerical or [ Professional.

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

95th

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_

February 16,

19_

78

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

(Type or print name and title of above official)

(Signature of Authorizing Official)

Louis Stokes

(Type or print name of Authorizing Official)

Chadisan

(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 1 1977)

NW 88326

Docld:32239476 Page 5

---

## Page 6

ME M

CURANDUM

TO :

Thomas Howarth, Budget Officer

PROM: I. Charlos Mathens, special counsel CAM

DATE:

February 14, 1978

RE:

Mr. Robert Lehner

Effective Tuesday, February 28, 1978, Robert Lehner

will be terminated from the Committee payroll.

If you have any questions concerning this matter,

please contact me at your convenience.

ICM: J

NW 88326

Docld:32239476 Page 6

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## 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 action:

•Employee Name (First-Middle-Last)

Robert d. Lehner

Employee Social Security Number

Effective Date: 10

December 1, 1977

Type of Action

871-28-5111

Employing Office or Committee:

Assassinations

• Appointment

82 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

Deputy Chief Counsel

$45,500

?. (If Committee Employee, complete appropriate item below.):.tom

• WE Standing Committee: Staff - Clerical or B] Professional:

2. 00: Special or Select Committee: Authority-H. Res. A65

3. E 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 1

19 21

(Signature of Authorizing Official) *

Louis Stokes

(Type or print name of Authorizing Official)

Chairman

eb

(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 88326

Docld:32239476 Page 7

---

## Page 8

PAYROLL AUTHORIZATION FORM

Please Use Typewriter

or Ballpoint Pen)

U.S. HOUSE OF REPRESENTATIVES

Washington, D.C. 205.15

(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)

Robert J, Lehner

Employee Social Security Number

071-28-5111

Employing Office or Committee

Assassinations

Effective Date

8/1/77

Type of Action

• Appointment

L 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

Deputy Chief Counsel

42,500

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

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

2. ly Special or Select Committee: Authority-H. Res: _465

_of_95th Congress:

3. I 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__.

August 2

.., 19 77

(Signature of Authorizing Official)

LOUIS STOKES

(Type or print name of Authorizing Official)

CHAIRMAN.

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 88326

Docld:32239476 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:

Employee Name (First-Middle-Last)

Effective Date

Robert i. Lahner

071 28 5111

7/17/77

Employee Social Security Number

Type of Action

Employing Office or Committee

Assassinations

• Appointment

I 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:

536, 000

(If Committee Employee, complete appropriate item below.)

1. _ Standing Committee: Staff- Clerical or Professional.

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

465

- of 25th.

-_Congress.

3. I Joint Committee.

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

Position Number_.

__If applicable; Level.

Step-

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

relatives.

Date:

July 14

., 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, must

be approved by the Committee on House Administration.

APPROVED:

Chairman, Committée on House Administration

Office of Finance use only:

Office Code.

Monthly Annuity S_

00

HA Comm.

1115/17

Copy for Initiating Office or Committee

NW 88326

Docld:32239476 Page 9

---

## Page 10

i U.S. GOVERNMENT PRINTING OFFICE: 1977-80-199

PAYROLL AUTHORIZATION FORM

(Please Use Typewriter

or Ballpoint Pen)

U.S. HOUSE OF REPRESENTATIVES

Washington, D.C. 20515

(Any erasures, cotrections, 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)

Robert J. Lehner

Employee Social Security Number

Effective Date

7/17/77

Type of Action

071 28 5111

Employing Office or Committee

Assassinations

• Appointment

Salary Adjustment

1 Termination (Ar close of business on effective date)

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

Position Title

Gross Annual Salary

$36,000

(If Committee Employee, complete appropriate item below.)

I. L standing Committee: Statt-_ Clerical or 4 Professional.

2. [X Special or Select Committee: Authority-H. Res._465__ of 95th_Congress.

7-377 11 3:01

Hor2, FINANCE OFF C"

3. 0

Joint Committee.

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

Position Number_

If applicable, Level

.. Step_

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

relatives.

Date_-

May/ 10, 1977

(Signature of Authorizing Official)

Louis Stokes

(Type or print name of Authorizing Official)

Chairman

TARAN

h 14

1012

(Title - If Member, District and State)

All appointments and sqlary 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_

NW 88326-

Docld:32239476 Page 10

00

---

## 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

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)

Robert J. Lehner

Effective Date

7/17/77

Employee Social Security Number

Type of Action

071 28 5711

Assassinations

Employing Office or Committee

• Appointment

Salary Adjustment

I Termination (At close of business on effective date)

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

Position Title

Gross Annual Salary

$36,000

(If Committee Employee; complete appropriate item below.)

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

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

465

-of 25th_ 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_

Nay 10

1971

(Signature of Authorizing Official)

Louis Stokes

(Type or print name of Authorizing Official)

Chairman

• 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. i

APPROVED:

Chairman, Committee on House Administration

Office of Finance use only:

Office Code.

Monthly Annuity $

POM

.00

Copy for Initiating Office or Committee

NW 88326

Docld:32239476 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)

Robert J. Lehner

Effective Date

4/1/77

Employee Social Security Number

Type of Action

073 28 5117

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

$47,500

(If Committee Employee, complete appropriate item below.)

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

2: L& Special or Select Committee: Authority-H. Res..

465

of 95th_ Congress.

3. I Joint Committee.

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

Position Number_

If applicable, Level.

Step-

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

relatives.

Date _

April 29

--, 19_1?

(Signature of Authorizing Official)

Louis Stokes

(Type or print name of Authorizing Official)

Chairman

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 88326

Docld:32239476 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:

Robert J. Lehner

Employee Name (First-Middle-Last)

Employee Social Security Number

Effective Date

2-1-77

Type of Action

071-28-5111

Employing Office or Committee

Select Committee on Assassinations

• Appointment

d. 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

$22,140.

(If Committee Employee, complete appropriate item below.)

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

11

95

Special or Select Committee: Authority-H. Res.

_ of

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

relatives.

2-28-77

Date -

19

Henry B. Gonzale a whoring officili

(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 Jöint Committees, must

be approved by the Committee on: House Administration.

APPROVED:

Chairman, Committee on House Administrationi

Office of Finance use.only:

Office Code.

Monthly Annuity: $

.00

Copy for Initiating Office or Committee

NW 88326

Docld:32239476 Page 13

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## Page 14

GPO: 1975 0-57-255

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:

hereby authorize the following payroll action:

Employee Name (First-Middle-Last).

Robert J. Lehner

Employee Social Security Number

Effective Date

1/3/77

Type of Action

071 28 5111

Employing Office or Committee

• Appointment

7 Salary Adjustment

• Termination (At close of business on effective date)

Select Committee on Assassinations

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

Position Title

Gross Annual Salary

$23,400.

(If Committee Employee, complete appropriate item below.)

] Standing Committee: Staff - Clerical or • Professional:

2.3 Special or Select Committee: Authority-H. Res. 17-

otg5--_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.

(Signature of Authorizing Official)

Henry B. Gonzalez

(Type or print name of Authorizing Official)

Chairman

(Title - If Member, District and State):

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

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

be approved by the Committee on House Administration.

APPROVED:

Chairman, Committee on House Administration

Öffice of Finance use only:

Office Code

Monthly Annuity $

NW 88326

.Docld:32239476 Page 14

.00

Copy for Initiating Office or Committee

---

## 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

Robert Joseph Lehner

Employee Social Security Number

12/6/76

Type of Action

973 28 5111

Employing Office or Committee

* Appointment

Ö Salary Adjustment :

• Termination (At close of business on effective date)

Select Committee on Assassinations

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

Position Title

Gross Annual Salary

Deputy Chief Counsel

$35,000

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

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

2. 7 Special or Select Committee: Authority - H. Res. 1640

_ Congress:

3.

Joint Committee:

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

Position. Number_.

If applicable, Level.

Step_

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

relatives.

Date_

December

., 1976

(Signature of Authorizing Official)

Thenas Me Downing, Chairman

(Type or print name of Authorizing Official)

Select Committee on Assassinatious

- If Member, District and State)

* raAll 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 88326

Docld:32239476 Page 15

---

## Page 16

MEMORANDUM

TO:

All Staff Employees

FROM: Budget Officer

DATE: January 3, 1977

RE:

Payroll Certification

Starting with the January, 1977 payroll, the certification

to the House Finance Office requires, among other things, the

relationship, if any, of each staff employee to any current

Member of Congress (those taking office January 3, 1977) •

The following are the relationships to be included in

the certification:

father

mother

SOL

daughter

brother

sister

uncle

aunt

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

first cousin

All stuff 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

robert Shm

ignature ef Employee

anuary24111)

Date

NW 88326

Docld:32239476 Page 16

---