аЯрЁБс>ўџ ;=ўџџџ:џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС#` јП…bjbj\.\. :,>D>D… џџџџџџЄPPPPPPPd, , , , H <dЅњ І І І І    $&&&&&&$ŸhМJPі   і і JPPІ І л_і ^PІ PІ $і $PPІ „ @MЮY$Ч, TXЬu0ЅУjУУPH >П ,ы $ ч   JJњ   Ѕі і і і ddddШ ddddШ dddPPPPPPџџџџ Statement Concerning Your Employment in a Job Not Covered by Social Security Employee NameEmployee ID # (SSN)myWSU ID #Employer NameТщЖЙДЋУНгГЛ­ГіЦЗEmployer ID#48-6029925 Your earnings from this job are not covered under Social Security. When you retire, or if you become disabled, you may receive a pension based on earnings from this job. If you do, and you are also entitled to a benefit from Social Security based on either your own work or the work of your husband or wife, or former husband or wife, your pension may affect the amount of the Social Security benefit you receive. Your Medicare benefits, however, will not be affected. Under the Social Security law, there are two ways your Social Security benefit amount may be affected. Windfall Elimination Provision Under the Windfall Elimination Provision, your Social Security retirement or disability benefit is figured using a modified formula when you are also entitled to a pension from a job where you did not pay Social Security tax. As a result, you will receive a lower Social Security benefit than if you were not entitled to a pension from this job. For example, if you are age 62 in 2005, the maximum monthly reduction in your Social Security benefit as a result of this provision is $313.50. This amount is updated annually. This provision reduces, but does not totally eliminate, your Social Security benefit. For additional information, please refer to Social Security Publication, “Windfall Elimination Provision.” Government Pension Offset Provision Under the Government Pension Offset Provision, any Social Security spouse or widow(er) benefit to which you become entitled will be offset if you also receive a Federal, State or local government pension based on work where you did not pay Social Security tax. The offset reduces the amount of your Social Security spouse or widow(er) benefit by two-thirds of the amount of your pension. For example, if you get a monthly pension of $600 based on earnings that are not covered under Social Security, two-thirds of that amount, $400, is used to offset your Social Security spouse or widow(er) benefit. If you are eligible for a $500 widow(er) benefit, you will receive $100 per month from Social Security ($500 - $400=$100). Even if your pension is high enough to totally offset your spouse or widow(er) Social Security benefit, you are still eligible for Medicare at age 65. For additional information, please refer to Social Security Publication, “Government Pension Offset.” For More Information Social Security publications and additional information, including information about exceptions to each provision, are available at  HYPERLINK "www.socialsecurity.gov" www.socialsecurity.gov. You may also call toll free 1-800-772-1213, or for the deaf or hard of hearing call the TTY number 1-800-325-0778, or contact your local Social Security office. I certify that I have received Form SSA-1945 that contains information about the possible effects of the Windfall Elimination Provision and the Government Pension Offset Provision on my potential future Social Security benefits. Signature of EmployeeDateForm SSA-1945 Revised: 12/06 MN\]^rst~€ŽЇЈЉЕЖСТ5 6 Њ Ћ   † ‡ є ѕ ў џ  ‘ №чначначЧЛЎЅž”Š}tž”}tчnчnчnчnчnчht\чh•1Sh•1S5\^J h•1S^J hF_ ^Jh•1ShF_ ^JhF_ hF_ OJQJ^JhF_ OJQJ^Jh•1ShF_ 5^J hF_ 5^Jh•1Sh˜)і^JhF_ h˜)іOJQJ^Jh˜)іh˜)і56^Jh˜)і56^JhF_ h•1SOJQJ^Jh•1Sh•1S5^Jh•1Sh•1S^Jh•1Sh•1S5CJ\^JaJ$.MN\]^rsѓѓъммммм $7$8$H$IfgdF_ 7$8$H$gd•1S $7$8$H$a$gd•1S…ўst€m\N $7$8$H$IfgdF_ $$7$8$H$Ifa$gd˜)і‘kd$$If–l”:жr”џј€`А"œ*dˆрP ь tрі6ііжџџџџџжџџџџџжџџџџџжџџџџџ4ж4ж laіyt˜)і€ЈЉЖСІ˜˜˜‡˜$$7$8$H$Ifa$gd˜)і $7$8$H$IfgdF_ Xkd$$If–l”:ж0”џА"œ*#ь tрі6ііжџџжџџжџџжџџ4ж4ж laіyt˜)іСТУџ  ы ь ”•уoffffffffff 7$8$H$gd•1SkdА$$If–lжr”џј€`А"œ*dˆрP ь tрі6ііжџџџџџжџџџџџжџџџџџжџџџџџ4ж4ж laіyt˜)і ‘ ’   | } э ю a b в г ъ ы ь {|щъTU”•tuфц[\бвтуфљkl}~ЂЃЄКЛ]^_ЧШ01CњёњёњёњёњёњёытжёњёњёњёњёњёњёњёњёњёытжёњёЪУБЪІЪёњёы™жжжhF_ 5\^Jh˜)іhF_ CJ^JaJhmтh•1S0J^J"jЌhmтhmт>*U^J hmт>*^Jjhmт>*U^Jh•1Sh•1S5\^Jh•1ShF_ ^J h•1S^Jh•1Sh•1S^J hF_ ^J8уфљ^_DE[\abіііііішшшш $7$8$H$IfgdF_ 7$8$H$gd•1S CDEZ\`abcdejstƒ„…їчлвлвТвАЇž’‰‚uhh˜)іhymCJ^JaJh•1Sh•1SCJ^JaJ hMф\^JhMф5\^Jh•1Sh•1S5\^Jh•1Sh•1S^JhфlU5\^J#hфlUhфlUCJOJQJ\^JaJhF_ hF_ 5OJQJ\^JhF_ 5\^Jh•1ShF_ 5\^Jh˜)іhF_ 5CJ\^JaJh•1S5\^Jbcd[M $7$8$H$IfgdF_ ЃkdR$$If–lжж\”џШ р(#œ*4 џџџџHџџџџt tрж0џџџџџџі6ііжџџџџжџџџџжџџџџџџџџџџжџџџџ4ж4ж laіyt˜)іde„…’…ƒ Ц0*7$8$H$gdMфlkdT$$If–lж”пж”џœ*+џџџџ tрж0џџџџџџі6ііжџџџџжџжџжџ4ж4ж laіyt˜)і8 00P:p•1SАа/ Ар=!Аа"Аа#а$а%ААаАа аў$$If–!vh5жd5жˆ5жр5жP 5жь#vd#vˆ#vр#vP #vь:V–l”: tрж0џџџџџџі6і,ж5жd5жˆ5жр5жP 5жь/ж џ/ж џyt˜)іЎ$$If–!vh5ж#5жь#v##vь:V–l”: tрж0џџџџџџі6і,ж5ж#5жь/ж џyt˜)іњ$$If–!vh5жd5жˆ5жр5жP 5жь#vd#vˆ#vр#vP #vь:V–l tрж0џџџџџџі6і,ж5жd5жˆ5жр5жP 5жь/ж џ/ж џyt˜)іІDаЩъyљКЮŒ‚ЊKЉ РFwww.socialsecurity.govџџ­о$$If–!vh5ж4 5ж5жH5жt#v4 #v#vH#vt:V–l tрж0џџџџџџі6і,ж5ж4 5ж5жH5жt/ж џџџџџџџџ/ж џ/ж џџџџџџџџ/ж џyt˜)іІ$$If–!vh5ж+#v+:V–l”п tрж0џџџџџџі6і,ж5ж+/ж џџџџџџџџ/ж џyt˜)і†œH@ёџH Normal CJOJQJ_HaJmH sH tH DA@ђџЁD Default Paragraph FontRi@ѓџГR  Table Normalі4ж l4жaі (kєџС(No Listjš@Гѓj •1S Table Grid7:Vж0џџџџџџ6U@Ђ6 mт Hyperlink >*B*phџ… ,џџџџ.MN\]^rst€ЈЉЖСТУџыь”•у ф љ ^ _ D E [ \ a b c d e „ ‡ ˜0€€˜0€€˜0€€Љ0€€а Љ0€€а Љ0€€а Љ0€€а Љ0€€а ˜0€€ Љ0€€а Љ0€€а ™0€€д Љ0€€а Љ0€€а Љ0€€а Љ0€€а Љ0€€а ™0€€д ˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€Љ0€€а Љ0€€а Љ0€€а Љ0€€а ™0€€д Љ0€€а ™0€€д ˜0€€˜0€€љ ^ _ D E [ \ b c „ ‡ {‰0єla{‰0y‰0y‰0y‰0y‰0 y‰0 {‰0€may‰0 y‰0Ь Д‘ C… s€Суbd… … } Ѓ К … Xџ€№8№@ёџџџ€€€ї№’№№0№( № №№B №S №ПЫџ ?№џџЗPJИPМqFЙPŒHКPф3—‡ –œЇЇ‡ =*€urn:schemas-microsoft-com:office:smarttags €PlaceName€=*€urn:schemas-microsoft-com:office:smarttags €PlaceType€9*€urn:schemas-microsoft-com:office:smarttags€place€ $yWtyce[]]_‘1 3 ~ ƒ ‡ e „ ‡ MУ56ЊЋ†‡єѕўџ‘’|}эюabвгъы{|щъTU”•tuфц[ \ б в т у k l } Л   ] ^ Ч Ш 0 1 C e s ƒ „ ‡ ~ ƒ ‡  х F_ •1SфlUё[ymц*УmтMфбчќpэ,я˜)іN\]^rst€ЈЉЖСТE [ \ a b c d e ‡ žž–ž–џ@€ƒ ƒ ˆ)Wƒ ƒ … @@џџUnknownџџџџџџџџџџџџG‡z €џTimes New Roman5€Symbol3& ‡z €џArialCF‡ŸComic Sans MS"qŒ№аhTу“&ХЂЌf | ˜* | ˜*q#№ааxЃ‚€r4э э 2ƒ№KX)№џ?фџџџџџџџџџџџџџџџџџџџџџ•1S2џџ-Statement Concerning Your Employment in a JobShelly KelloggShelly Kelloggўџр…ŸђљOhЋ‘+'Гй0Є˜амє  4@ ` l x„Œ”œф0Statement Concerning Your Employment in a JobShelly KelloggNormalShelly Kellogg4Microsoft Office Word@Ј[щ@0~"Ы3Х@F–ћX$Ч | ўџеЭеœ.“—+,љЎDеЭеœ.“—+,љЎp, hp”œЄЌ ДМФЬ д фТщЖЙДЋУНгГЛ­ГіЦЗ*˜э Ћ .Statement Concerning Your Employment in a Job TitleА 8@ _PID_HLINKSфAh&"www.socialsecurity.gov›  ўџџџўџџџ !"#$%&'()ўџџџ+,-./01ўџџџ3456789ўџџџ§џџџ<ўџџџўџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџRoot Entryџџџџџџџџ РF0—аY$Ч>€Data џџџџџџџџџџџџ1TableџџџџУWordDocumentџџџџ:,SummaryInformation(џџџџџџџџџџџџ*DocumentSummaryInformation8џџџџџџџџ2CompObjџџџџџџџџџџџџqџџџџџџџџџџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџ џџџџ РFMicrosoft Office Word Document MSWordDocWord.Document.8є9Вq