[180-10070-10176.pdf — page 2]
# OFFICE OF THE CLERK## U.S. HOUSE OF REPRESENTATIVES# PERSONAL LEAVE RECORD## 1977YEARZEVNIK P.A.Name of EmployeeAddressAddressPhone NumberDATE OF APPOINTMENT1-1-77ANNUAL LEAVECATEGORY1.0BALANCE BROUGHTFORWARD FROMPRECEDING YEARAnnualLeaveSickLeavePosition TitlePosition NumberLevelStepPRIOR FEDERAL SERVICE1.52.0Years Months| 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 3 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 |     || Jan.  | /                                                                                   | /                  | /                    | /               | 1                         | 1                 |            |     || Feb.  | /                                                                                   | /                  | /                    | /               | 2                         | 2                 |            |     || Mar.  | /                                                                                   | /                  | /                    | /               | 3                         | 3                 |            |     || Apr.  | /                                                                                   | /                  | /                    | /               | 4                         | 4                 |            |     || May   | /                                                                                   | /                  | /                    | /               | 5                         | 5                 |            |     || June  | XXXXXX                                                                              | -                  | -                    | 5               | 5                         | 0                 | 0          | 5   || July  |                                                                                     |                    |                      |                 |                           |                   |            |     || Aug.  |                                                                                     |                    |                      |                 |                           |                   |            |     || Sept. |                                                                                     |                    |                      |                 |                           |                   |            |     || Oct.  | Terminated June 17, 1977                                                            |                    |                      |                 |                           |                   |            |     || Nov.  |                                                                                     |                    |                      |                 |                           |                   |            |     || Dec.  |                                                                                     |                    |                      |                 |                           |                   |            |     |= 0.5 day annual leave= 1.0 day annual leave= 0.5 day sick leaveS or S = 1.0 day sick leave= 0.5 day administrative leaveA or A = 1.0 day administrative leave= 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:32244118 Page 3