[180-10068-10332.pdf — page 2]
# OFFICE OF THE CLERK## U.S. HOUSE OF REPRESENTATIVES# PERSONAL LEAVE RECORD## 1977YEARDAY, ClarenceName of EmployeeAddressAddressPhone NumberPosition Titla|                 |       |      || --------------- | ----- | ---- || Position Number | Level | Step |DATE OF APPOINTMENT6-27-77ANNUAL LEAVE CATEGORY1.  01.  52.  0PRIOR FEDERAL SERVICEYears Months|                                                                                     |                 |                    |                      |                   |                   || ----------------------------------------------------------------------------------- | --------------- | ------------------ | -------------------- | ----------------- | ----------------- ||                                                                                     | BALANCE BROUGHT |                    |                      | BALANCE           |                   ||                                                                                     | FORWARD FROM    |                    |                      | AT CLOSE          | EMPLOYEE INITIALS ||                                                                                     | PRECEDING YEAR  | ACCRUED THIS MONTH | AVAILABLE THIS MONTH | USED THIS MONTH   | OF MONTH          || Month                                                                               | DAY OF MONTH    | Annual. Sick Leave | Annual Sick Leave    | Annual Sick Leave | Annual Sick Leave || 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.                                                                                |                 | / /                |                      |                   | 7 7               || Feb.                                                                                |                 | / /                |                      |                   | 8 8               || Mar.                                                                                |                 | / /                |                      |                   | 9 9               || Apr.                                                                                |                 | / /                |                      |                   | 10 10             || May                                                                                 |                 | / /                |                      |                   | 11 11             || June                                                                                | XXX XXXXXX      | / /                | / /                  | 4                 | 88 12             || July                                                                                |                 | / /                | / /                  | 8 17 8            | 0 13              || Aug.                                                                                |                 |                    |                      |                   |                   || Sept.                                                                               |                 |                    |                      |                   |                   || Oct.                                                                                |                 |                    |                      |                   |                   || Nov.                                                                                |                 |                    |                      |                   |                   || Dec.                                                                                |                 |                    |                      |                   |                   |0.5 day annual leavoCERTIFIED CORRECT:1.  0 day annual leave2.  5 day sick leaveSor S 1.0 day sick leaveEmployee's Signature(If employee refuses to sign, state reason below.DateChief's SignatureDate3.  5 day administrative leaveA or A 1.0 day administrative leaveApproved:Clerk of the HousaDate4.  5 day unauthorized absenceU or U = 1.0 day unauthorized absenceThis 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..5.  5 day leave without pay6.  0 day leave without payEXHIBIT INW 88326Docld:32243298 Page 3