[180-10068-10345.pdf — page 2]
# OFFICE OF THE CLERK## U.S. HOUSE OF REPRESENTATIVES### PERSONAL LEAVE RECORD#### 1977![personal leave record form]FALLIS S.J.DATE OF APPOINTMENT: 12-7-76ANNUAL LEAVE CATEGORY:1.0PRIOR FEDERAL SERVICE:1.52.0| 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  |     || ----- | --- | --- | --- | --- | --- | ---- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- || Jan.  |     |     |     |     |     |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || Feb.  |     |     |     |     |     |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || Mar.  |     |     |     |     |     |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || Apr.  |     |     |     |     |     |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || May   |     |     |     |     |     |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || June  |     |     |     |     |     |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || July  | X   |     |     |     |     |      |     |     |     |     | X   |     |     |     |     | S   |     |     |     |     |     | X   |     |     |     | X   |     |     |     |     |     |     || Aug.  |     |     |     |     |     |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || Sept. |     |     |     |     |     | AXXX |     |     |     |     |     |     | X   |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || Oct.  |     |     |     |     |     |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || Nov.  |     |     |     |     |     |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || Dec.  |     |     |     |     |     |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |ACCRUED THIS MONTH AVAILABLE THIS MONTH USED THIS MONTH BALANCE AT CLOSE OF MONTH| Annual Leave | Sick Leave | Annual Leave | Sick Leave | Annual Leave | Sick Leave | Annual Leave | Sick Leave || ------------ | ---------- | ------------ | ---------- | ------------ | ---------- | ------------ | ---------- || /            | /          |              |            |              |            | 1            | 1          || /            | /          |              |            |              |            | 2            | 2          || /            | /          |              |            |              |            | 3            | 3          || /            | /          |              |            |              |            | 4            | 4          || /            | /          |              |            |              |            | 5            | 5          || /            | /          |              |            |              |            | 6            | 6          || /            | /          | 7            | 7          | 3            | 1          | 4            | 6          || /            | /          | 5            | 5          |              | 1          | 4            | 7          ||              |            | 4            |            | 7            |            | 0            | 7          ||              |            |              |            |              |            | 4            |            |Terminated 9/12/77= 0.5 day annual leave= 1.0 day annual leave= 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 DateChief's Signature DateApproved:Clerk 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 88326Docld:32243311 Page 3