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CHARDAK B.A.Name of EmployeeAddressAddressPhone NumberPosition Title| Position Number | Level | Step || --------------- | ----- | ---- |OFFICE OF THE CLERKU.S. HOUSE OF REPRESENTATIVESPERSONAL LEAVE RECORD1977YEAR|                              |                       || ---------------------------- | --------------------- || DATE OF APPOINTMENT          | ANNUAL LEAVE CATEGORY || 11-29-76                     | 1.  0                 || PRIOR FEDERAL SERVICE        | 1.  5                 ||                              | 2.  0                 || Years _______ Months _______ |                       ||                                             |              || ------------------------------------------- | ------------ || BALANCE BROUGHT FORWARD FROM PRECEDING YEAR |              || Annual Leave /                              | Sick Leave / ||       |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |       |     |     |     |       |       |       |     |     |     |     |     |     |     |   ACCRUED  THIS MONTH    |   AVAILABLE THIS MONTH   |    USED THIS MONTH     | BALANCE AT CLOSE OF MONTH | EMPLOYEE INITIALS |     || ----- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | ----- | --- | --- | --- | ----- | ----- | ----- | --- | --- | --- | --- | --- | --- | --- | :----------------------: | :----------------------: | :--------------------: | :-----------------------: | :---------------: | --- || Month | 1   | 2   | 3   | 4   | 5   | 6   | 7   | 8   | 9   | 10  | 11  | 12  | 13  | 14  | 15  | 16  | 17  | 18    | 19  | 20  | 21  | 22    | 23    | 24    | 25  | 26  | 27  | 28  | 29  | 30  | 31  | Annua Leave   Sick Leave | Annua Leave   Sick Leave | Annua Leave Sick Leave |  Annua Leave  Sick Leave  |                   |     || Jan.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |       |     |     |     |       |       |       |     |     |     |     |     |     |     |        /       /         |                          |                        |         2      2          |                   |     || Feb.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |       |     |     |     |       |       |       |     |     |     |     |     |     |     |        /       /         |                          |                        |         3      3          |                   |     || Mar.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |       |     |     |     |       |       |       |     |     |     |     |     |     |     |        /       /         |                          |                        |         4      4          |                   |     || Apr.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |       |     |     |     |       |       |       |     |     |     |     |     |     |     |        /       /         |                          |                        |         5      5          |                   |     || May   |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |       |     |     |     |       |       |       |     |     |     |     |     |     |     |        /       /         |                          |                        |         6      6          |                   |     || June  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | A     |     |     |     |       |       |       |     |     |     |     |     |     |     |        /       /         | 7   0             7   6  |           1            |     6      7        7     |                   |     || July  |     |     |     |     |     |     |     |     |     |     |     |     |     |     | A   |     |     | X   X |     |     |     | X   X | X   X | X   X |     |     |     |     |     |     |     |        /       /         |    7               8     |           7            |         0      8          |                   |     || Aug.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |       |     |     |     |       |       |       |     |     |     |     |     |     |     |                          |                          |                        |                           |                   |     || Sept. |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |       |     |     |     |       |       |       |     |     |     |     |     |     |     |                          |                          |                        |                           |                   |     || Oct.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |       |     |     |     |       |       |       |     |     |     |     |     |     |     |                          |                          |                        |                           |                   |     || Nov.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |       |     |     |     |       |       |       |     |     |     |     |     |     |     |                          |                          |                        |                           |                   |     || Dec.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |       |     |     |     |       |       |       |     |     |     |     |     |     |     |                          |                          |                        |                           |                   |     |Terminated 7/31/77= 0.5 day annual leave= 1.0 day annual leaveS = 0.5 day sick leaveS or S = 1.0 day sick leaveA = 0.5 day administrative leaveA or A = 1.0 day administrative leaveU = 0.5 day unauthorized absenceU or U = 1.0 day unauthorized absence= 0.5 day leave without pay= 1.0 day leave without payCERTIFIED CORRECT:Employee's Signature Date(If employee refuses to sign, state reason below.)Approved: Chief's Signature DateClerk of the House DateThis record will be forwarded to the Clerk of the House at the end of each calendar year, or in case of termination, along with the request for termination. Upon approval, the record will be filed in the employee's official personnel folder.EXHIBIT INW 88326DocId:32243288 Page 3