“14-00000 15374 S-E-C-R-E-T LIVE JRS RAICE AFTLICATION (COTUCT LIE) POLICY 10. 46 RE OF zPLovm (p) 9/24/15 Jevvy grand K. Benndam ENSESTIVE DATE 9-25-62 TOTAL PREMIUM PAID 29.00 . . DATE OF DIRT MONTHLY PREMIUM ACUAL/p- SALAIC 13,730 INSURANCE CLASS. IL (CH”
“14-00000 IMVRANCH APPLICATION IICLICY No. (CCenor live) FECTIVE NAME CP wozorez (2) 1 Ct Mee PAID. 0• ..0 20 Vos’ bsz ‘Date of Insurance • 411 vs /., J Premium *- iSalary : 77>": : Class CVes Veekask iRooN zzo. P(ccx APPRCPRLA2 BLOCK) Malo 0 Full-time employee iimo”
“XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX OFFICE USE ONLY1 LER accepted as an Additional Claim (Earnings exceed eligibility amount.) Date of Claim Office ‘Representative N ‘NW 88326 Docld:32243329 Page 6”
“14-00000 El Medicare Vithe" WRUL Jurrica # Conering Amountt #2,733.75 Carlin Clark # -3-69784 1344 1-3100 -.?7 . * 7. 1-15 Nov 1389 16 - 30 Nor $ 667.0 376168 9 316.25 ) is Arcreent 1399 1-31 hlec. $1 $1,923.75 382709 B1 316.25 1419 1-31 Jun SELT ooks Check”
“ccounting facilitice. **Dependent payments - Wife 100, cad, child and adels Capentent $50 each. AC/H Aichael J. King AUTHENTICATING OFFICES Copy Ma i SEARET REPRODUCTION BY OTHER THAN THE ISSUING OFFICE IS PRONEBITED. NW 65990 Docld:32383590 Page 1”
“PMT. BEN. NET PERIOD EFFECTIVE R W 1DEN. IDEN. BEGIN. MONTHLY AMOUNT AMOUNT AMOUNT F 1 CODE CODE DATE RATE DUE FROM TO FROM TO D C REMARKS PIA 71.00 Wills 202 2/27/5 P Wilks KnBinks 6065 2/27/05 /27/45 RoBirk NW 88326 Docld:32245128 Page 55”
“9 Forss OA -C589 JS DEPARTMENT OF W HEALTH, EDUCATION, AND WELFARE Always give SOCIAL SECURITY ADMINISTRATION Claim No. 433-54-3937-E when writing about your claim 10-14-64 nowledged of the following: DESCRIPTION OF REMITTANCE AMOUNT SCHEDULE NO. sonal check dated 10-6-”
“icr- go, (a) Fully Loxablo ponsions and annuities (not reported on Schadulo E 3. )l. C) Alimony. ,7. . 4s *o.............. .. * • (s) Othor (stata estuire cng cource)...... -......................... -- C (Votrttaqeclkscous Incog (had lines 40(a), G) and (c)) .... 40 W, eo- ”
“P A Y M E N T C EN TER _ □ OP LE A S E A D V IS E C U R R E N T D IS T R IC T O F F IC E F C L A IM S STATU S (P R E P A R E O A -C 5 5 6 ) P R IO R C E R T IF IC A T IO N (S E E O V E R ) REQUEST DATE TYPE ACTION BLOCK NUMBER ACCOUNT NUMBER I DISTRICT OFFICE CODE 1 7 6”
“action described in paragraph 2 above.. Case 0123: (201-293105) Monthly payment reduced by; 50.00 Case *132; (201-300027) Monthly payment reduced by: 25.00 4. Station took action in terminating the payment for Case #82 (201-300091) effective with the January 1967 payment”
“should herse w a deduction of $14.70 fu the month Pay, which would give TICHBYS saxderm credits (4277-20) for 106. Tomrefore, 1t is requested that ths Station refund Junject sury FICA that was withheld after a deduction or $14.70 for Moy, and pleons note this odlontment in the wo”
“14-00000 1 5-cENGG ACTION 3_ DISPAuCh infiJ for A: % CINEr 0: Imne N) index.nS 812.220 CNLY caunu Cea SIGSBIES* dief, CAN sol INGIN Pdar or Cta-ion, "exies cits 1MISFOF LBS "Ke g-kodintuvelen - - FLO RUUPNAS 1.. Co-mittce representative seventeen in vidanis wa”
“-hiev-stt wchtniddstiniitntici. Mr -'.’-.r ronst uiar or 1 i OnGs Si- s "Nr i UNm _SECRET___ i,i "i a i Pare: • CALLE StCRLtAmAf DISSEMINATION [] melx jto INDEX 3RCrnN 10 BRANCH FILE RIO fir PtR__________ r. FILE it Cs FILE NO. CoNri 5 FILE, va. (classification) ”
“enrollment h ho (Month, Day, Yew) (Mamik, Dey, Yeor) Iself only; saswe Wife ®f Iitem 1. If onrell Husband |ment H for tell ond’ Norma E OCT 29, 43 CD [4) lemily, also emww item 2. a IF YOU ARE (3] (0] CHANGING YOW ENROLLMENT ALSO FILL n EII / PART D. 5) 1o PART C PLA”
“payment level of tho second and third dependents after the remarriage of the mother, was followed. Logically, the termination of payments to dependents in any of the top categories would automatically lead to an adjustment in status and payment to not only children, but in s”
“iholndidicanslesn. an. SECRET 1 ! ci 5 6 (When Filled In) 0: 1__ /tro, !__ Gortgo @e*B0bUCTION or this C ------------- •CH1A1TF: ,— 13 7 ----------- 14 8 JNI 29 7 32 FH 7I were- to ‘I AUTIO, Sony WIS F FILE,7 VR O: OP2, CCS2, CSPS, OF2 797 SECR E T 20221 Z ”
“NT 1 4-00000 PSIUDON rM JONSDRING comFONINT cawO jixig-oi seergoeeepeat StAIMS Cm DAM CIiPeNSpr PERSONAL DATA cuRntat rs Post HOTUNE no POST reclv QA/l) CATS Q0:m134 OM NONT INCOAMATION (‘votes VOI Rremren: %-TaN ROAR in (a was RELATIONSHIP . - t or aA • .onANyar AEVLH W”
“14-00000 --eroaiv-eotys,, Grayston Seroy .77 2686 PARI I COMPENSATION AND WITHHOLDING Data sour s nr COVr *. A r% PA $• S wouantr pt <: 4. OvreNSatio PAYMENTS Dy Cavy * AMOUNT sunsrtto TAG !N V. 15 uac e rep- vIX Pete) ,9500 1 9500 MAV*S" PEieis Iri AMOUNT AN, TOTAL BY G”
“- Case #87: (201-300082) Monthly payment reduced by: 50.00 Case #89; (201-297752) ir Monthly payment terminated on basis of First dependent's statement to survey case worker that she was fiancee and engaged to be married following return of 201-297752. Total amount ter”
“,NAME ADDRESS. James & Parmen Ruse __ IDENTIFICA. ON NO. 322-11-1997 BCRECMER NO. 0 50 SGOEOULE OF DEDUCTIONS YEAR ENDED PDV ■ I’ CEDERAL >STATE CONTRIBUTIONS ramt & STATE A!7 07 CAL X 0ER 0. ) 00100.A033 ■S -03 200 CHURCHES 1000 • /v — COMMUNITY CHEST/UNITED CRUSADE_”
“14-00000 0»at? beer us vicom (P) /6 MENT OF CLAIM f. ; Mlm*A s RUMBEe 1 SEX 1 CODE I COuhen AMBER I DLlNGNT RELATONsHp TLA E CLAINTIGEORREO 35’121 902 DOlf 5-16-85 AUDIT BREAKDOWN MOUNTS 1AOUat5. ACCUMULATION OF DEDUCude I Kentt. Ado soon Date — 5-1C-65 .ie ACTUAL I”
“Security Department. 9. WELFARE, VETERANS AND SOCIAL SECURITY PAYMENTS and cer- tain other kinds of government benefits cannot be gar 10. BANKRUPTCY OR A WAGE EARNER PLAN may be a way to protect yourself from repeated garnishments. Y/ I ******************************** NW 88”
“Department of Form OA-C107 (5-64) ’ Health, Education, and Welfare Form Approved by Comptroller General, U.S. DETERMINATION OF Social Security Administration January 28, 1955 RESUMPTION OF AWARD RAWLINS ST, DISTRICT OFFICE ACCOUNT NUMBER 3716 DACCAS ITEX / 0 H 433-54-393”
“14-0000. CLASSInab MESSAGE geemrets ROUTING Ret P ■ - M/3-3u4s8 1 4 2 5 TO : DIRECTOR 3 6 IFROM : JMWAVE la a M M ffiM ^ m iiK O * ACTION: SAS 8 INFO :FD 2, DDP, OP 2, S/C 2 OC D L IN57726 S ECRET112344Z F DIR CITE WAVE 9623 TYPIC FINANCE 12 JUN 1963 REF UF”
“subject to change If premium Is increased or decreased) —... SAVINGS ’BONDS tt up ona RETIREMENT WITHHELD IN UNITED STATES __ 10.66 OTHER (Specify in detail) Kra. El 1zabeth C. Miler__ 98.23 (Name ut Allottee) Address Home Addrama------- TOTAL GRCES SALARY PER PAY PERIO”
“FORM OA-C528b (4-64) KC DISTRICT OFFICE CLAIM NO. PIC DETERMINATION OF TERMINATION OF ENTITLEMENT 433-54-3937 E W. E. OR SUSPENSION OF PAYMENTS BASED ON SUPPORTING EVIDENCE ON FILE ADJMT. CODING DATE A9 ___ 10/16/64 CR. BLOCK NO. w-0402OT‘64 KC Marina N. Oswald DAT”
“PART If 100 Want 10 MONTH DAT TEAR D.ANG tout LRO MINT PART E Feb } WANING. —Any Ialantianal telse tutement • All WHO - sis appliance or walitul miss epresuntation saludive 20 El sto:STER , the 9to is a vlotullon of the Inw gunishable by'a ithee » * not more than $1”
“FORM OA-C528b (4-64) KC 3 DISTRICT OFFICE CLAIM NO. PIC DETERMINATION OF TERMINATION OF ENTITLEMENT 433-54-3937-E E W. E. OR SUSPENSION OF PAYMENTS BASED ON SUPPORTING EVIDENCE ON FILE ADJMT. CODING DATE CR. BLOCK NO. 6/7/65 Marina N. Oswald W-0208 JUN ’65 KC INITIAL”
“COMPENSATION UNDER CONDITIONS ENTITLING HIM TO RETAIN HIS ure INSURANCE, ATTACH CURRI NT SF 54, IF ANY, 10. ORIGINAL SF 56 AND CHICK BOX, I (a) ON ORIGINAL AND All COPIE § OF SF 56. IF NO CURRENT SF 54 15 ON Fill. CHECK BOX 4 (6). IN All OTHER CASES. SHOW WHrHER O NOT CURRINT.S”
“14-00000 S-3-C-N-B-T (When Fillsa ln) 6/4/28 6 COMPLETE IN DUPLICAT o & R-TUl.N CTI CoPR-b To 1He INSURANCE E. AN THPS -ADMNSTR/TV CH. lcopnALE •TIN FPPLICATIC::: - LC iul WRIT. IN THIS BLSSK, (CONTRACT PLAN) ------------------------------------------------------ - _ POL”
“tiki. 1/ X 2 tis y**4r" - ‘ • hst"ee,n-9 firn, then your smired t’dd vn undny oje 19. mefurfing fersolly odfop-te * rhiden, 4 €‘ez-**-e ond dlleg-tat ebt’dian -) , I with Pol in a regular porent chid relor.se sh.p ricl,sla also any unmarried e*44 rvsn. *? -1- became disabled”
“fo r wages of o v e r $125 a m o n th OR (0 ] NO - re n d e rin g s u b s ta n tia l s e rv ic e s in s e lf-e m p lo y m e n t? a [ YET NO IDAIL SIGNATURE SOCIAL SECURITY CLAIMNUMBER D ALN D o Sly GRE 7 4-5- 66 < 467 82 4034 -***/ +., MrsMarina*N * .*P- orter *2 . nuf”
“paid during the preceding six-month period, merely set out the amount paid during that period (under 26. b. (2) (a)). "SECRET - NO FOREIGN DISSEMINATION" 36 10-15-74 NW 88321 Docld:32989529 Page 1781”
“i^m^w^nK'M2**21988917 F * PYXESCN NBV %*2LNC*--*hwSAtatgxtehXo BYXS4 34 CNS3MP09,*3*51,0.42 W#36ToldACEThiANAly NAME ADDRESS Samuel RPayllis Ruby322-12-7997 SOC. SEC. NO. CALENDAR YEAR .19 74 DEDUCTION SCHEDULE MEDICAL STATE FEDERAL CONTRIBUTIONS STATE FEDERAL 2 MEDICINE”
“the number to which I am entitled, and that the information relative to sources of income shown Hereon is correct. DATE iGNED (Pivudonse) re ,% 313 SECRET «HI”
“deductions for the life insurance. Shil ard L. City 12 July 1962 DISTRIBUTION : / 3-Finance Division 2-Wh Division 2-Files 1110 ligo D21 16.00 11122 Of tent 02 11 165 117 itif:ta Mun t = Pre cn/j. 4 dad »> SECRET wrtlan vegsveulite-Fe9*9Hn”
“your? (3 trawst @rouat9f. is "Yas," ortec’s a ducso-’e reetiferite / 0 MACE AN "4 let Rite I re CL6 2, wry ou VIR PPMIS area Ar,>€S TEA) PART C fu.nets 9. 3 alact not t enroll Is any pion - 5Ti.e season t.s - n’A ion proper ho.h PART IF YOU under the Meolih Seen Act. gre3 1”
“14-00000 SECREr COVERT AGREEMENT SUPPLE ( - INCOME AND FEDERAL TAX DAT d’e IX. Irving C. DEVUONO L sod• 2877 PART I COMPENSATION AND WITHHOLDING DATA SoIrCE Ss COMPENSATION PymiNto (Cher) •pereer vote) Mlanussreus JIFLO ALLOTANT Cewresarios PAYVENTS By COVER AC Lily HA”
“1 that he will receive z la U. S. Treasury form 1099 at the end of each taxable year, showing Roberts as his source of income. Therefore, it is incumbent on AMIRE/ 1 to file an overt tax return listing himself as an independent contractor with Roberts, thereby explaining why ”
“DEDUCTIONS PMT. BEN. NET PERIOD EFFECTIVE R W IDEN. IDEN. BEGIN. MONTHLY AMOUNT AMOUNT AMOUNT F I CODE CODE DATE RATE DUE FROM TO FROM TO D C E 37.60 9/64 9/64 37.60 E 37.50 AA 37.50 E 10/64 31.40 9/64 9/64 31.40 2 31.30 REMARKS PIA 71.00 AA-Excess refund received o”
“Department of Form OA-C107 (2-64) fe Health, Education, and Welfare DETERMINATION OF Form Approved by Comptroller General, U.S. Social Security Administration January 28, 1955• RESUMPTION OF AWARD DISTRICT OFFICE CLAIM NUMBER 3716 Rawlins St. Dallas, Tex. 75219 433-54-3937”
“OSTENSIBLE EmpLBvrR I 10.’ DECLAVATION OF ESTIMATED INCOME TAX (Check one) HAS DECN FILED A HAS Nor BEEN FILfO NOT APPLICABLE PART II DEPENDENCY DATA 11. NO. or DEPENDENTS. INCLUDING SELF. Clatudo =1Ta covta tr. NO. or DEPENDENTS, INCLUDING SELP, CLAIMED ON FACILITY. NA F”
“WILL BE TAKEN. (9 If you receive the check before hearing from the Treasury Department kb you should notify the social security district office shown above. You 0 -may use the enclosed post card to notify us. After sending in this noti a fication, you may cash the check. ”
“(NoWiLLY GRANTED ONLY TO RESIDENTS OF TUB UNIT D STATES) 31. QUARTERS 32. POST 33. OTHER Mone None None 34. COVCA (Breakdown, if any)' SECTION VI TRAVEL 35. TYPES 36. WITH DEPENDENTS % AC# oowgaree oPEoaTromaL ,191114* opraartonat mx ves 37. HHE TO BE SHIPPED STA. NHE TO ”
“W^isotiitre PREVIOUS DISTRICT OFFICE DEPARTMENT OF NEW DISTRICT OFFICE HEALTH, EDUCATION, AND WELFARE SOCIAL SECURITY Administration 3716 NS ST PAYEE, ADDRESS CHANGE. OR HOLD CHECK REQUEST PIC DAL DATE WAGE EARNER CLAIM NO. 05/05/65 06 FLOA LLOA MBA 2 3 433 54 3937 E ”
“14-00000 "GARCIA AND PAULA" TRUST ACCOUNT * Jh Y21 Paid to recruit's dependents (See Annex 1). $ 44,225.00 Transferred to Saving Accounts. (See Annex 2). 52,000.00 WMI Reimbursed to Garcia and Paula. (See Annex 3). 30,150.00 RIM S®. ’ Total deposited in Trust A”
“sign even if only one had income) € Address (and ZIP Code) 367-34-8729 Preparer's Emp. Ident. or Soc. Sec. No. 016—83229-1. 18717 VANOWEN STREET.( VAN NUYS, CA. 91403 s. 367-34-8729\ NW, 88326 .Docld:32245535 Page 53”
“not paid on Bureau [ authority.. 15 E 5. Receipts.......... ,................................... .. .............. .. 15 [ 6. Income tax returns....................... 16 [ 7. Stipulation re payments made to witnesses 16 [- 8. Receipt of unemployment compensation.......... 1”
“■ NAME ADDRESS. Samuel & Phyliss Rucy ) IDENTIFICATION NO. 322 - 12 -7997 SCHEDULE NO SCHEDULE OF DEDUCTIONS YEAR ENDED. MEDICAL FEDERAL STATE CONTRIBUTIONS FEDERAL & STATE 1. ONE HALF OF MEDICAL INSURANCE (NOT OVER 5130.00) 100 6 150 00 CHURCHES 2. DRUGS AND MEDICINE”
“Department of Form OA-C107 (5-64) DETERMINATION OF Health, Education, and Welfare Form Approved by Comptroller General, U.S. 9% Social Security Administration January 28, 1955 ; k RESUMPTION OF AWARD de DISTRICT OFFICE ACCOUNT NUMBER 433-54-3937 E THE FOLLOWING DETERMINAT”