[180-10060-10442.pdf — page 2]
# OFFICE OF THE CLERK## U.S. HOUSE OF REPRESENTATIVES### PERSONAL LEAVE RECORD#### 1977YEARHITCHCOCK, C.F.Name of EmployeeAddressAddressPhone NumberPosition TitlePosition Number Level StepDATE OF APPOINTMENT1-1-77PRIOR FEDERAL SERVICEYears MonthsANNUAL LEAVE CATEGORY1.  02.  53.  0BALANCE BROUGHT FORWARD FROM PRECEDING YEAR| Annual Leave | Sick Leave || ------------ | ---------- ||              |            || ---          | ---        || Month | DAY OF MONTH                                                                        | Accrued This Month | Available This Month | Used This Month | Balance at close of month | Employee Initials |            |              |            |     |     || ----- | ----------------------------------------------------------------------------------- | ------------------ | -------------------- | --------------- | ------------------------- | ----------------- | ---------- | ------------ | ---------- | --- | --- ||       | 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                | Annual Leave      | Sick Leave | Annual Leave | Sick Leave |     |     || Jan.  |                                                                                     |                    | /                    | /               |                           |                   |            |              |            |     |     || Feb.  |                                                                                     |                    | /                    | /               |                           |                   |            |              |            |     |     || Mar.  |                                                                                     |                    | /                    | /               |                           |                   |            |              |            |     |     || Apr.  |                                                                                     |                    | /                    | /               |                           |                   |            |              |            |     |     || May   |                                                                                     |                    | /                    | /               |                           |                   |            | 5            | 5          |     |     || June  | XXX XX                                                                              |                    | 0                    | 0               |                           | 5                 |            | 5            | 0          | 0   | 5   || July  |                                                                                     |                    |                      |                 |                           |                   |            |              |            |     |     || Aug.  |                                                                                     |                    |                      |                 |                           |                   |            |              |            |     |     || Sept. |                                                                                     |                    |                      |                 |                           |                   |            |              |            |     |     || Oct.  |                                                                                     |                    |                      |                 |                           |                   |            |              |            |     |     || Nov.  |                                                                                     |                    |                      |                 |                           |                   |            |              |            |     |     || Dec.  |                                                                                     |                    |                      |                 |                           |                   |            |              |            |     |     |Terminated June 7, 19770.  5 day annual leave1.  0 day annual leave2.  5 day sick leaveSor S = 1.0 day sick leaveAor A = 0.5 day administrative leaveAor 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 88326Docld:32239450 Page 3![NW 88326 Docld:32239450 Page 3]