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# OFFICE OF THE CLERK## U.S. HOUSE OF REPRESENTATIVES# PERSONAL LEAVE RECORD## 1977& ANNON, THOMAS M.Name of EmployeeAddressAddressPhone NumberPosition TitleDATE OF APPOINTMENT: 12-13-76ANNUAL LEAVE CATEGORY:1.01.52.0PRIOR FEDERAL SERVICE:Years MonthsBALANCE BROUGHT FORWARD FROM PRECEDING YEAR:Annual Leave: ---Sick Leave: ---| Position Number | Level | Step |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |              |            |              |            |                 |                 |                           |                           |                   || --------------- | ----- | ---- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | ------------ | ---------- | ------------ | ---------- | --------------- | --------------- | ------------------------- | ------------------------- | ----------------- || 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  | Annual Leave | Sick Leave | Annual Leave | Sick Leave | Used This Month | Used This Month | Balance at Close of Month | Balance at Close of Month | EMPLOYEE INITIALS || Jan.            |       |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | /            | /          |              |            |                 |                 | 1                         | 1                         |                   || Feb.            |       |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | /            | /          |              |            |                 |                 | 2                         | 2                         |                   || Mar.            |       |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | /            | /          |              |            |                 |                 | 3                         | 3                         |                   || Apr.            |       |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | /            | /          |              |            |                 |                 | 4                         | 4                         |                   || May             |       |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | /            | /          |              |            |                 |                 | 5                         | 5                         |                   || June            |       |      |     |     |     |     |     |     |     |     |     |     | X   | X   | X   | X   | X   | X   | X   |     |     |     |     |     |     |     |     |     |     |     |     | 0            | 0          | 5            | 5          | 0               | 0               | 5                         | 5                         |                   || July            |       |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |              |            |              |            |                 |                 |                           |                           |                   || Aug.            |       |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |              |            |              |            |                 |                 |                           |                           |                   || Sept.           |       |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |              |            |              |            |                 |                 |                           |                           |                   || Oct.            |       |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |              |            |              |            |                 |                 |                           |                           |                   || Nov.            |       |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |              |            |              |            |                 |                 |                           |                           |                   || Dec.            |       |      |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |              |            |              |            |                 |                 |                           |                           |                   |Terminated June 17, 19770.  5 day annual leave= 1.0 day annual leave0.  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.)Chief'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 88326DocId:32243318 Page 3