EXHIBIT 3

 

EQUAL EMPLOYMENT OPPORTUNITY COMMISSION

BALTIMORE FIELD OFFICE
10 South Howard Street, 3RD Floor
Baltimore, MD

 

____________________________________

                                            

Walter Flournoy,                                  

on behalf of himself                             

and all other persons similarly situated,      

                                                     

Class Agent,                                 

 

v.

        

Sean O’Keefe, Administrator                        

National Aeronautics and                     

Space Administration,                          

                                                     

Agency.                      

____________________________________

 

 

Agency No. NCN-92-GSFC-F064

EEOC No. 120-A2-1267

 

 

                                                                                                           

 

RELEASE OF CLAIMS AGAINST NASA GODDARD SETTLEMENT

FUND AND ADMINSTRATORS OF THE FUND

                                                                                                           

 

         This Release of Claims against the NASA Goddard Settlement Fund and the Administrators of the Fund is made and executed by the undersigned Class Member:

         Recitals:

1.            I am one of the Class Members as defined in the Settlement Agreement (the “Agreement”) in the above-captioned class action complaint.

2.            I wish to receive an award from the Settlement Fund (the “Fund”) created pursuant to the Agreement, and I have been informed that I will receive an award from  the Fund if I sign and return to the Administrators of the Fund this Release and certain other documents. 

3.            I understand that I may be entitled to a fixed amount payment from the Fund.  I also understand that the payment of the employee portion of all taxes on such payment is my sole responsibility.

NOW, THEREFORE, in consideration of the benefits to be provided to me under the Agreement, the receipt and sufficiency of which I acknowledge, I agree as follows:

On receipt of payment from the Fund, I, for myself, my heirs, executors, administrators and assigns, unconditionally, irrevocably, fully and finally release and forever discharge the Fund, the Administrators, and the Trustees from all liabilities and claims.

I KNOW AND FULLY UNDERSTAND THE CONTENTS OF THIS RELEASE AND EXECUTE IT FREELY, BEING FULLY AWARE OF ITS FULL AND FINAL EFFECT.

On penalty of perjury pursuant to 28 U.S.C. § 1746, I state that I am the person identified in the Release, that all of the factual statements herein are true and correct, and that my signature signifies acceptance of all terms of this Release.

Date:                                                                                 

                                                      Class Member’s Signature

 

                                                                                         

                                                      Class Member’s Typed or Printed Name

 

                                                                                         

                                                      Class Member’s Social Security Number