Form SSA-1.

ATCHISON TOPEKA AND SANTA FE RAILWAY COMPANY

___________________________________________

(City)                           (State)                             (date)

Section 8-(1) of the Selective Training and Service Act of 1940 reads in part as follows:

"It is the expressed policy of the Congress that whenever a vacancy is caused in the employment rolls of any business or industry by reason of induction into the service of the United States of an employee, pursuant to the provisions of this Act, such vacancy shall not be filled by any person who is a member of the Communist Party or of the German-American Bund.

I hereby declare that I am not a member of the Communist Party or of the German-American Bund.

I understand that the truth of the foregoing declaration is a material condition precedent to the employment for which I am hereby applying.

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(Signature)