Originator: CIA
Document date: 1976-12-13 00:00:00
Document type: PRINTED FORM

# DOCID-32243308

## Page 1

Date: 08/20/93

Page: 1

JFK ASSASSINATION SYSTEM

IDENTIFICATION FORM

AGENCY INFORMATION

AGENCY : HSCA

RECORD NUMBER: 180-10068-10342

RECORDS SERIES :

STAFF PAYROLL RECORDS

AGENCY FILE NUMBER :

DOCUMENT INFORMATION

ORIGINATOR : HSCA

FROM :

TO :

TITLE :

Released under the John F.

Kennedy Assassination

Records Collection Act of

1992 (44 USC 2107 Note].

Case#:Nw 66000 Date:

41-04.2021

DATE : 12/13/76

PAGES : 12

SUBJECTS :

HSCA, ADMINISTRATION

EVANS, EDWARD M.

DOCUMENT TYPE : PRINTED FORM

CLASSIFICATION : U

RESTRICTIONS : 3

PRINTED FORM

CURRENT STATUS : P

DATE OF LAST REVIEW: 07/07/93

OPENING CRITERIA :

COMMENT'S :

Box. #:1.

[R] - ITEM IS RESTRICTED

NW 66000

Docld:32243308 Page 1

---

## 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:

Edward H. Evans

Employee Name (First-Middle-Last)

Employee Social Security Number.

Effective Date

December 1s 1978

Type of Action

129-22-1305

Employing Office or Committee/Subcommittee

Assassinacions

• Appointment

30 Salary Adjustment

• Title Change

• Termination (At close of business on effective date)

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

$47,500.00

* 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. D Standing Committee: Staff— Clerical or • Professional.

2. El Special (Investigative staff of Standing Committee) or Select Committee: Authority-H. Res. 956 of 5th-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.

Date

Decenber 11, 1978

19

Ilf 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 nome of Authorizing Official)

Chairman

(Title - If Member, District and State)

All appointments and salary adjustments for employees under the Housé 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:32243308 Page 2

---

## Page 3

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)

Edward

Evans

Employee Social Security Number

129-22-1805

Employing Office or Committee/Subcommittee

Aesassinations

Effective Date

12/31/78

Type of Action

• Appointment

• Salary Adjustment

• Title Change

É Termination (At close of business on effective date)

• Leave without pay (Beginning with effective date above and 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 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. I Special (Investigative staff of Standing Committee) or Select Committee: Authority-H. Res 956

3. 0

Joint Committee.

-of 25 tE: Congress.

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

Position Number_.

If applicable, Level,

Step_

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

relatives.

Date:

January 2

79

19

Tif 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)

-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:

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:32243308 Page 3

---

## 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)

Edward N. Evans

Employee Social Security Number

Effective Date

Decenter 1, 1977

Type of Action

329-22-1805

Employing Office or Committee/Subcommittee

Assassinations

• Appointment

Be Salary Adjustment

• Title Change

• Termination (At close of business on effective date)

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

close of business_

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

Position Title

Chief Investigator

Specify Date

Gross Annual Salary*

$38,500

* 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. l

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

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

- of 35 t*: 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. 3.110(b), prohibiting the employment of

relatives.

Becameer 1

Date_

77

19.

22211244

(Signature of Authorizing Official)

Louis Stokes

Ilf 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:.

ed

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:32243308 Page 4

---

## Page 5

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)

Edward M. Evans

Employee Social Security Number

129- 22-1805

• Effective Date

8/1/77

Type of Action

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

Chief Investigator

36,000

(If Committee Employee, complete appropriate item below:)

1.

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

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

455

__of_

95 til Congress.

3.

_ Joint Committee.

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

Position Number_.

If applicable; Level

Step:--

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

relatives.

Date_

August 2

77

, 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, Committee on House Administration:

Office of Finance use only:

Office Code

Monthly Annuity S-

.00

Copy for Initiating Office or Committee

NW 66000

Docld:32243308 Page 5

---

## Page 6

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)

Edward M. Evans

Employee Social Security Number

129 22 1805

Effective Date

5/29/77

Type of Action

Employing Office or Committee

• Appointment.

K Salary Adjustment

• Termination (At close of business on effective date)

Assassinations

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

Position Title

Gross Annual Salary

$30,000

(If Committee Employee; complete appropriate item below.)

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

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

465

_of 95th.

- Congress.

3.1

• 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: 31:10(b); prohibiting the: employment of.

relatives.

Date_

May. -

10

_, 1927

Signature of Authorizing Officiall

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:

÷37.

Office of Finance use only:

Office Code

Monthly Annuity S_

5/11

00

• Copy for Initiating Office or Committee

NW 66000

Docld:32243308 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 action:

Employee Name (First-Middle-Last)

Effective Date

Eduard M. Evans

4/1/77

Employee Social Security Number

• Type of Action

129 22 1805

Employing Office or Committee

• Appointment

*Salary Ädjustment

• Termination (At close of business on effective date)

Assassinations

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

Position Title

Gross Annual Salary

$47,500

(If Committee Employee, complete appropriate item below.)

Standing Committee: Staff -_ Clerical or M Professional.

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

465 of_25kh 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-??

(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 66000

Docld:32243308 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:

Edward M.. Evans

Employee Name (First-Middle-Last)

Employee Social Security Number

Effective Date

2-7-77

Type of Action

129-22-7805

Employing Office or Committee

Select Committee on Assassinations

• Appointment

[a 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

$18,450.

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

1. A

Standing. Committee: Staff- Clerical or • Professional:

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

95

__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. 3.110(b), prohibiting the employment of

relatives.

2-28-77

Date-

19

(Signature of Authorizing Official)

Henry B. Gonzalez

(Type or print name of Authorizing Official)...

Chairman

(Title - If Member, District and State)

wAll 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.

•46-1 ...

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:32243308 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:

Edward W. Evans

129 22. 1305

Employee Name (First-Middle-Last)

Employee Social Security Number

Effective Date

1/3/77

Type of Action

Employing Office or Committee

Select Coumittee on Assassinetions

• 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

$19,500.

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

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

2.1E Special or Select Committee: Authority - H: Res.

3. 0 Joint Committee.

of 25th-

Congress.

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

Position Number.

If applicable, Level!.

Step_

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

relatives.,

Date.

77

19.

(Signature of Authorizing Official)

Henry B.

Gonzalez

(Type or print name of Authorizing Official)

Chairman

(Title - If Member, District and State)

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

ployees, except those of the Committee on Appropriations, the Committee on the Budgét, 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:32243308 Page 9

---

## Page 10

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, It 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.

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 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

ture of Emp

21017)

NW 66000

Docld:32243308 Page 10

---

## Page 11

PAYROLL INFORMATION FORM AND PERSONNEL AFFIDAVIT

PLEASE USE TYPEWRITEE OR PRINT IN INK

CODE:

Finance Office Use Only

U.S. HOUSE OF REPRESENTATIVES

Name

EVANS, EDWARA M

(Last-First-Miuale)

Employing Office

Social Security No. 129-22-1805

Date of birth

3-22-31

(Month-Day-fear)

ADDRESSES

Mailing address for payroll check (Bank, home, office,

Mailing address for withholding tax statement:

1280 21* STREET NW

c/O LAWSON

WASHINGTON D.C.

FINANCE OFFICE USE ONLY

Bank Code:

Bank Account No. (Do not insert Bank Account Number unless chacis

is to be mailed to a bank)

PREVIOUS FEDERAL CIVILIAN SERVICE

• House of Representatives-Office of

Separation date of last service

• Other Federal Departments (including Senate and Architect)

Agency

Separation date of last service

• Name (if different from present signature) -

While employed as above I was covered by :

Federal Employees' Health Insurance: • enrolled; • not enrolled; [ excluded.

Federal Employees' Life Insurance: • optional; I regular; • waived; • excluded.

anscene

ELECTION OF RETIREMENT COVERAGE

Coverage under the provisions of the Civil Service Retirement Act is extended to employees of the House

of Representatives on a voluntary basis. Once you have elected this coverage and retirement deductions

have been withheld, such deductions cannot be discontinued so long as you are continuously employed

under the Act.

Check the appropriate box to the right:

YES

• I elect coverage under the provisions of the Civil Service Retirement Act and request that deduc-

tions begin at the earliest possible date. (If you have had previous Federal or Military service,

please submit dates, Agencies and Military Serial Number on a separate sheet.)

NO

I do not wish to elect coverage under the Retirement Act at this time.

(Note: Legislative employees are not covered by the Social Security Act.)

bairaid

(Signature)

(Over)

18-82058-1

NW 66000

Docld:32243308 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:

Edward M. Evans

Employee Name (First-Middle-Last)

Employee Social Security Number

Effective Date

12/13/76

Type, of Action

129 22 7805

-Employing Office or Committee

Select Committee on Assassinations

& Appointment

• Salary Adjustment

I Termination (At close of business on effective dáte).

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

Position Title

Chief Investigator-King

Gross Annual Salary

$26,000

(If Committee Employee, complete appropriate item below.)

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

2. E Special or Select Committee: Authority-H. Res.1540-

_of#th _Congress.

3. L 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

., 1975

(Signature of Authorizing Official)

Thomas N. Downing,

Chairman

(Type or print name of Authorizing Official)

Select Committee on assassinations

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:32243308 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

coward H.

evans

Employee Social Security Number

1/1/77

Type of Action

129 26 7305

Employing Office or Committee

• Appointment

708 Salary Adjustment

• Termination (At close of business on effective date)

Select Committee on Assassinaticas

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

Position Title

Gross Annual Salary

$00,091

Chief Investigator

(If Committee Employee, complete appropriate item below.)

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

2. E Special or Select Committee: Authority-H. Res. LE

_of 24 Li_ 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 30

., 1976

(Signature of Authorizing Official)

Thonas i

downing,

Chairmon

(Type or print name of Authorizing Official)

Select Cousclee on Assassinations

mber, 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:32243308 Page 13

---