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MEMBER ENROLLMENT INFORMATION
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| Policy Number: 000001 |
Division Number: 00001 |
| Member Name: |
JOHNSON,MARLENE R |
| Social Security Number: |
111-11-9999 |
| Address: |
423 WIND RD |
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| City: |
LINCOLN |
| State: |
NE |
| Zip: |
68501 |
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| Date of Birth: |
06/13/1963 |
| Gender: |
Female |
| Class: |
01 – All eligible members |
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| Department #: |
000001 |
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| Full Time Date of Hire: |
11/30/2004 |
| Occupation: |
OFFICE MANAGER |
| Hours Worked: |
40 |
| Earnings Paid: |
Salary |
| Dep Coverage: |
Waived |
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