FORM AD-334

 USDA

 (REV. 8/17) 

SOCIAL SECURITY NO. PAY PERIOD DATE MO DA YR MO DA YR P/P T&A CONTACT POINT ACCT. 

STAT. 

ORGANIZATIONAL STRUCTURE PERSNL 

OFFICE PAY PLAN GR. STEP 

SALARY RATE TYPE 

EMPL. SCD FOR LEAVE RET. DEDUCTIONS THIS APPOINTMENT STATEMENT OF EARNINGS AND LEAVE 

EARNINGS AND DEDUCTIONS 

ITEM HOURS AMOUNT 

CODE DESCRIPTION P/P YR. TO DATE P/P YR TO DATE 

YEAR TO DATE LEAVE STATUS YEAR TO DATE LEAVE STATUS PT. HRS 

UNAPP MAX. C/O TYPE ACCRUED USED BALANCE TYPE ACCRUED USED BALANCE PROJECTED 

USE OR LOSE 

CREDIT HOURS-BY PAY PERIOD ANN 

RELIGIOUS COMP-BY PAY PERIOD SICK LEAVE CATEG 

TRAVEL COMP-BY PAY PERIOD COMP 

MILITARY REMARKS 

TIME OFF AWARD 

BPAPRA COMPENSATORY 

BPAPRA OBLIGATED DEBT 

DISABLED VETERAN LEAVE 

TYPE 1ST YEAR 2ND YEAR 3RD YEAR BALANCE 

REST. ANN. LEAVE HRS. 

NAME AND ADDRESS 

AGENCY HR ADDRESS

EPP

Case 24-44337-mxm7 Doc 7 Filed 11/21/24 Entered 11/21/24 16:04:31 Desc Main

Document Page 1 of 14
FORM AD-334

 USDA

 (REV. 8/17) 

SOCIAL SECURITY NO. PAY PERIOD DATE MO DA YR MO DA YR P/P T&A CONTACT POINT ACCT. 

STAT. 

ORGANIZATIONAL STRUCTURE PERSNL 

OFFICE PAY PLAN GR. STEP 

SALARY RATE TYPE 

EMPL. SCD FOR LEAVE RET. DEDUCTIONS THIS APPOINTMENT STATEMENT OF EARNINGS AND LEAVE 

EARNINGS AND DEDUCTIONS 

ITEM HOURS AMOUNT 

CODE DESCRIPTION P/P YR. TO DATE P/P YR TO DATE 

YEAR TO DATE LEAVE STATUS YEAR TO DATE LEAVE STATUS PT. HRS 

UNAPP MAX. C/O TYPE ACCRUED USED BALANCE TYPE ACCRUED USED BALANCE PROJECTED 

USE OR LOSE 

CREDIT HOURS-BY PAY PERIOD ANN 

RELIGIOUS COMP-BY PAY PERIOD SICK LEAVE CATEG 

TRAVEL COMP-BY PAY PERIOD COMP 

MILITARY REMARKS 

TIME OFF AWARD 

BPAPRA COMPENSATORY 

BPAPRA OBLIGATED DEBT 

DISABLED VETERAN LEAVE 

TYPE 1ST YEAR 2ND YEAR 3RD YEAR BALANCE 

REST. ANN. LEAVE HRS. 

NAME AND ADDRESS 

AGENCY HR ADDRESS

EPP CITIZENSHIP AND IMMIGRATION SERVICES 76065 - 0000

***-**-  04/07/2024 04/20/2024 07 CI-25-0120-05-14 0008 CI-26-00-0000 1699 GS 09 04 71660.00 PA F/T 01/02/2007 2943.02 01 REGULAR TIME 80.00 549.00 2747.20 18728.34 83838387888897** 

**

**626666**757576778183 61** 61 021510114040**

**

**

SICK LEAVE OTHER LEAVE TIME OFF AWARDS   PAY PERIOD HOURS & GROSS PAY ** ** ANNUAL LEAVE RETIREMENT TSP-FERS *AMT BASED ON FIXED AMT SOCIAL SECURITY (OASDI) FEDERAL TAX EXEMPTS MJ FEGLI- COVERAGE $ $74,000 FEHBA - ENROLL CODE 252 FEHBA - ENROLL CODE 315 DENTAL PLAN VISION PLAN UNION/ASSOCIATION DUES 52 3377 TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) MEDICARE TAX WITHHELD ********** TOTAL DEDUCTIONS ********** *************** NET PAY ************** DD/EFT ROUTING NO. ******** 80.00 55.00 48.00 4.00 64.00 2747.20 21.98 100.00 154.12 37.52 11.84 186.35 58.22 16.88 18.00 156.97 157.27 36.04 955.19 1792.01 1813.10 1594.56 130.64 24456.00 195.66 900.00 1372.71 406.03 105.60 419.66 1304.45 457.10 134.71 162.00 1412.73 1415.43 321.00 8607.08 15848.92 2189.36 56 59.00 204.50 116.50 240.00 28 10.00 27.75 8

DIRECT DEPOSIT IS FAST, SAFE AND CONVENIENT. 

FILE, RECEIVE REFUNDS, AND PAY YOUR TAXES 

ELECTRONICALLY. FOC PAYROLL 

124 LEROY 

ROAD 

WILLISTON VT 05495

Phone 802-657-7860

ERICA A JORDAN

3668 RAINWATER TRL

MIDLOTHIAN, TX 76065-0000

Official Pay Date 05/02/2024

FOC PAYROLL 

124 LEROY ROAD 

 

WILLISTON VT 05495

Phone 802-657-7860

Case 24-44337-mxm7 Doc 7 Filed 11/21/24 Entered 11/21/24 16:04:31 Desc Main

Document Page 2 of 14
FORM AD-334

 USDA

 (REV. 8/17) 

SOCIAL SECURITY NO. PAY PERIOD DATE MO DA YR MO DA YR P/P T&A CONTACT POINT ACCT. 

STAT. 

ORGANIZATIONAL STRUCTURE PERSNL 

OFFICE PAY PLAN GR. STEP 

SALARY RATE TYPE 

EMPL. SCD FOR LEAVE RET. DEDUCTIONS THIS APPOINTMENT STATEMENT OF EARNINGS AND LEAVE 

EARNINGS AND DEDUCTIONS 

ITEM HOURS AMOUNT 

CODE DESCRIPTION P/P YR. TO DATE P/P YR TO DATE 

YEAR TO DATE LEAVE STATUS YEAR TO DATE LEAVE STATUS PT. HRS 

UNAPP MAX. C/O TYPE ACCRUED USED BALANCE TYPE ACCRUED USED BALANCE PROJECTED 

USE OR LOSE 

CREDIT HOURS-BY PAY PERIOD ANN 

RELIGIOUS COMP-BY PAY PERIOD SICK LEAVE CATEG 

TRAVEL COMP-BY PAY PERIOD COMP 

MILITARY REMARKS 

TIME OFF AWARD 

BPAPRA COMPENSATORY 

BPAPRA OBLIGATED DEBT 

DISABLED VETERAN LEAVE 

TYPE 1ST YEAR 2ND YEAR 3RD YEAR BALANCE 

REST. ANN. LEAVE HRS. 

NAME AND ADDRESS 

AGENCY HR ADDRESS

EPP

Case 24-44337-mxm7 Doc 7 Filed 11/21/24 Entered 11/21/24 16:04:31 Desc Main

Document Page 3 of 14
FORM AD-334

 USDA

 (REV. 8/17) 

SOCIAL SECURITY NO. PAY PERIOD DATE MO DA YR MO DA YR P/P T&A CONTACT POINT ACCT. 

STAT. 

ORGANIZATIONAL STRUCTURE PERSNL 

OFFICE PAY PLAN GR. STEP 

SALARY RATE TYPE 

EMPL. SCD FOR LEAVE RET. DEDUCTIONS THIS APPOINTMENT STATEMENT OF EARNINGS AND LEAVE 

EARNINGS AND DEDUCTIONS 

ITEM HOURS AMOUNT 

CODE DESCRIPTION P/P YR. TO DATE P/P YR TO DATE 

YEAR TO DATE LEAVE STATUS YEAR TO DATE LEAVE STATUS PT. HRS 

UNAPP MAX. C/O TYPE ACCRUED USED BALANCE TYPE ACCRUED USED BALANCE PROJECTED 

USE OR LOSE 

CREDIT HOURS-BY PAY PERIOD ANN 

RELIGIOUS COMP-BY PAY PERIOD SICK LEAVE CATEG 

TRAVEL COMP-BY PAY PERIOD COMP 

MILITARY REMARKS 

TIME OFF AWARD 

BPAPRA COMPENSATORY 

BPAPRA OBLIGATED DEBT 

DISABLED VETERAN LEAVE 

TYPE 1ST YEAR 2ND YEAR 3RD YEAR BALANCE 

REST. ANN. LEAVE HRS. 

NAME AND ADDRESS 

AGENCY HR ADDRESS

EPP CITIZENSHIP AND IMMIGRATION SERVICES 76065 - 0000

***-**-  05/05/2024 05/18/2024 09 CI-25-0120-05-14 0008 CI-26-00-0000 1699 GS 09 04 71660.00 PA F/T 01/02/2007 2986.98 01 REGULAR TIME 80.00 709.00 2747.20 24222.74 83838387888897** 

**

**626666**757576778183 61** 61 021510114040**

**

**

SICK LEAVE OTHER LEAVE TIME OFF AWARDS   PAY PERIOD HOURS & GROSS PAY ** ** ANNUAL LEAVE RETIREMENT TSP-FERS *AMT BASED ON FIXED AMT SOCIAL SECURITY (OASDI) FEDERAL TAX EXEMPTS MJ FEGLI- COVERAGE $ $74,000 FEHBA - ENROLL CODE 252 FEHBA - ENROLL CODE 315 DENTAL PLAN VISION PLAN UNION/ASSOCIATION DUES 52 3377 TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) MEDICARE TAX WITHHELD ********** TOTAL DEDUCTIONS ********** *************** NET PAY ************** DD/EFT ROUTING NO. ******** 80.00 55.00 48.00 4.00 64.00 2747.20 21.98 100.00 154.12 37.52 11.84 186.35 58.22 16.88 18.00 156.97 157.27 36.04 955.19 1792.01 1813.10 1594.56 130.64 29950.40 239.62 1100.00 1680.95 481.07 129.28 419.66 1677.15 573.54 168.47 198.00 1726.67 1729.97 393.08 10517.46 19432.94 2189.36 72 59.00 220.50 116.50 240.00 36 10.00 35.75 8

DIRECT DEPOSIT IS FAST, SAFE AND CONVENIENT. 

FILE, RECEIVE REFUNDS, AND PAY YOUR TAXES 

ELECTRONICALLY. FOC PAYROLL 

124 LEROY 

ROAD 

WILLISTON VT 05495

Phone 802-657-7860

ERICA A JORDAN

3668 RAINWATER TRL

MIDLOTHIAN, TX 76065-0000

Official Pay Date 05/30/2024

FOC PAYROLL 

124 LEROY ROAD 

 

WILLISTON VT 05495

Phone 802-657-7860

Case 24-44337-mxm7 Doc 7 Filed 11/21/24 Entered 11/21/24 16:04:31 Desc Main

Document Page 4 of 14
FORM AD-334

 USDA

 (REV. 8/17) 

SOCIAL SECURITY NO. PAY PERIOD DATE MO DA YR MO DA YR P/P T&A CONTACT POINT ACCT. 

STAT. 

ORGANIZATIONAL STRUCTURE PERSNL 

OFFICE PAY PLAN GR. STEP 

SALARY RATE TYPE 

EMPL. SCD FOR LEAVE RET. DEDUCTIONS THIS APPOINTMENT STATEMENT OF EARNINGS AND LEAVE 

EARNINGS AND DEDUCTIONS 

ITEM HOURS AMOUNT 

CODE DESCRIPTION P/P YR. TO DATE P/P YR TO DATE 

YEAR TO DATE LEAVE STATUS YEAR TO DATE LEAVE STATUS PT. HRS 

UNAPP MAX. C/O TYPE ACCRUED USED BALANCE TYPE ACCRUED USED BALANCE PROJECTED 

USE OR LOSE 

CREDIT HOURS-BY PAY PERIOD ANN 

RELIGIOUS COMP-BY PAY PERIOD SICK LEAVE CATEG 

TRAVEL COMP-BY PAY PERIOD COMP 

MILITARY REMARKS 

TIME OFF AWARD 

BPAPRA COMPENSATORY 

BPAPRA OBLIGATED DEBT 

DISABLED VETERAN LEAVE 

TYPE 1ST YEAR 2ND YEAR 3RD YEAR BALANCE 

REST. ANN. LEAVE HRS. 

NAME AND ADDRESS 

AGENCY HR ADDRESS

EPP CITIZENSHIP AND IMMIGRATION SERVICES 76065 - 0000

***-**-  05/19/2024 06/01/2024 10 CI-25-0120-05-14 0008 CI-26-00-0000 1699 GS 09 04 71660.00 PA F/T 01/02/2007 3008.96 01 REGULAR TIME 40.00 749.00 1373.60 25596.34 83838387888897** 

**

**626666**757576778183 61** 61 021510114040**

**

**

SICK LEAVE OTHER LEAVE TIME OFF AWARDS   PAY PERIOD HOURS & GROSS PAY ** ** ANNUAL LEAVE RETIREMENT TSP-FERS *AMT BASED ON FIXED AMT SOCIAL SECURITY (OASDI) FEDERAL TAX EXEMPTS MJ FEGLI- COVERAGE $ $74,000 FEHBA - ENROLL CODE 252 FEHBA - ENROLL CODE 315 DENTAL PLAN VISION PLAN UNION/ASSOCIATION DUES 52 3377 TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) MEDICARE TAX WITHHELD ********** TOTAL DEDUCTIONS ********** *************** NET PAY ************** DD/EFT ROUTING NO. ******** 8.00 80.00 32.00 55.00 56.00 4.00 96.00 274.72 2747.20 21.98 100.00 154.12 37.52 11.84 186.35 58.22 16.88 18.00 156.97 157.27 36.04 955.19 1792.01 1098.88 1813.10 1869.28 130.64 32697.60 261.60 1200.00 1835.07 518.59 141.12 419.66 1863.50 631.76 185.35 216.00 1883.64 1887.24 429.12 11472.65 21224.95 3288.24 80 91.00 196.50 84.50 240.00 40 10.00 39.75 8

DIRECT DEPOSIT IS FAST, SAFE AND CONVENIENT. 

FILE, RECEIVE REFUNDS, AND PAY YOUR TAXES 

ELECTRONICALLY. FOC PAYROLL 

124 LEROY 

ROAD 

WILLISTON VT 05495

Phone 802-657-7860

ERICA A JORDAN

3668 RAINWATER TRL

MIDLOTHIAN, TX 76065-0000

Official Pay Date 06/13/2024

FOC PAYROLL 

124 LEROY ROAD 

 

WILLISTON VT 05495

Phone 802-657-7860

Case 24-44337-mxm7 Doc 7 Filed 11/21/24 Entered 11/21/24 16:04:31 Desc Main

Document Page 5 of 14
FORM AD-334

 USDA

 (REV. 8/17) 

SOCIAL SECURITY NO. PAY PERIOD DATE MO DA YR MO DA YR P/P T&A CONTACT POINT ACCT. 

STAT. 

ORGANIZATIONAL STRUCTURE PERSNL 

OFFICE PAY PLAN GR. STEP 

SALARY RATE TYPE 

EMPL. SCD FOR LEAVE RET. DEDUCTIONS THIS APPOINTMENT STATEMENT OF EARNINGS AND LEAVE 

EARNINGS AND DEDUCTIONS 

ITEM HOURS AMOUNT 

CODE DESCRIPTION P/P YR. TO DATE P/P YR TO DATE 

YEAR TO DATE LEAVE STATUS YEAR TO DATE LEAVE STATUS PT. HRS 

UNAPP MAX. C/O TYPE ACCRUED USED BALANCE TYPE ACCRUED USED BALANCE PROJECTED 

USE OR LOSE 

CREDIT HOURS-BY PAY PERIOD ANN 

RELIGIOUS COMP-BY PAY PERIOD SICK LEAVE CATEG 

TRAVEL COMP-BY PAY PERIOD COMP 

MILITARY REMARKS 

TIME OFF AWARD 

BPAPRA COMPENSATORY 

BPAPRA OBLIGATED DEBT 

DISABLED VETERAN LEAVE 

TYPE 1ST YEAR 2ND YEAR 3RD YEAR BALANCE 

REST. ANN. LEAVE HRS. 

NAME AND ADDRESS 

AGENCY HR ADDRESS

EPP CITIZENSHIP AND IMMIGRATION SERVICES 76065 - 0000

***-**-  06/02/2024 06/15/2024 11 CI-25-0120-05-14 0008 CI-26-90-0000 1699 GS 09 04 71660.00 PA F/T 01/02/2007 3030.94 01 REGULAR TIME 749.00 25596.34 83838387888897** 

**

**626666**757576778183 61** 61 021510114040**

**

**

SICK LEAVE OTHER LEAVE TIME OFF AWARDS   PAY PERIOD HOURS & GROSS PAY ** ** ANNUAL LEAVE RETIREMENT TSP-FERS *AMT BASED ON FIXED AMT SOCIAL SECURITY (OASDI) FEDERAL TAX EXEMPTS MJ FEGLI- COVERAGE $ $74,000 FEHBA - ENROLL CODE 252 FEHBA - ENROLL CODE 315 DENTAL PLAN VISION PLAN UNION/ASSOCIATION DUES 52 3377 TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) MEDICARE TAX WITHHELD ********** TOTAL DEDUCTIONS ********** *************** NET PAY ************** DD/EFT ROUTING NO. ******** 80.00 80.00 55.00 56.00 4.00 176.00 2747.20 21.98 100.00 154.12 37.52 11.84 186.35 58.22 16.88 18.00 156.97 157.27 36.04 955.19 1792.01 2747.20 1813.10 1869.28 130.64 35444.80 283.58 1300.00 1989.19 556.11 152.96 419.66 2049.85 689.98 202.23 234.00 2040.61 2044.51 465.16 12427.84 23016.96 6035.44 88 171.00 124.50 4.50 240.00 44 10.00 43.75 8

FOC PAYROLL 

124 LEROY 

ROAD 

WILLISTON VT 05495

Phone 802-657-7860

ERICA A JORDAN

3668 RAINWATER TRL

MIDLOTHIAN, TX 76065-0000

Official Pay Date 06/27/2024

FOC PAYROLL 

124 LEROY ROAD 

 

WILLISTON VT 05495

Phone 802-657-7860

Case 24-44337-mxm7 Doc 7 Filed 11/21/24 Entered 11/21/24 16:04:31 Desc Main

Document Page 6 of 14
FORM AD-334

 USDA

 (REV. 8/17) 

SOCIAL SECURITY NO. PAY PERIOD DATE MO DA YR MO DA YR P/P T&A CONTACT POINT ACCT. 

STAT. 

ORGANIZATIONAL STRUCTURE PERSNL 

OFFICE PAY PLAN GR. STEP 

SALARY RATE TYPE 

EMPL. SCD FOR LEAVE RET. DEDUCTIONS THIS APPOINTMENT STATEMENT OF EARNINGS AND LEAVE 

EARNINGS AND DEDUCTIONS 

ITEM HOURS AMOUNT 

CODE DESCRIPTION P/P YR. TO DATE P/P YR TO DATE 

YEAR TO DATE LEAVE STATUS YEAR TO DATE LEAVE STATUS PT. HRS 

UNAPP MAX. C/O TYPE ACCRUED USED BALANCE TYPE ACCRUED USED BALANCE PROJECTED 

USE OR LOSE 

CREDIT HOURS-BY PAY PERIOD ANN 

RELIGIOUS COMP-BY PAY PERIOD SICK LEAVE CATEG 

TRAVEL COMP-BY PAY PERIOD COMP 

MILITARY REMARKS 

TIME OFF AWARD 

BPAPRA COMPENSATORY 

BPAPRA OBLIGATED DEBT 

DISABLED VETERAN LEAVE 

TYPE 1ST YEAR 2ND YEAR 3RD YEAR BALANCE 

REST. ANN. LEAVE HRS. 

NAME AND ADDRESS 

AGENCY HR ADDRESS

EPP CITIZENSHIP AND IMMIGRATION SERVICES 76065 - 0000

***-**-  06/16/2024 06/29/2024 12 CI-25-0120-05-14 0008 CI-26-90-0000 1699 GS 09 04 71660.00 PA F/T 01/02/2007 3052.92 01 REGULAR TIME 40.00 789.00 1373.60 26969.94 83838387888897** 

**

**626666**757576778183 61** 61 021510114040**

**

**

SICK LEAVE OTHER LEAVE TIME OFF AWARDS   PAY PERIOD HOURS & GROSS PAY ** ** ANNUAL LEAVE RETIREMENT TSP-FERS *AMT BASED ON FIXED AMT SOCIAL SECURITY (OASDI) FEDERAL TAX EXEMPTS MJ FEGLI- COVERAGE $ $74,000 FEHBA - ENROLL CODE 252 FEHBA - ENROLL CODE 315 DENTAL PLAN VISION PLAN UNION/ASSOCIATION DUES 52 3377 TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) MEDICARE TAX WITHHELD ********** TOTAL DEDUCTIONS ********** *************** NET PAY ************** DD/EFT ROUTING NO. ******** 8.00 80.00 32.00 55.00 64.00 4.00 208.00 274.72 2747.20 21.98 100.00 154.12 37.52 11.84 186.35 58.22 16.88 18.00 157.27 36.04 798.22 1948.98 1098.88 1813.10 2144.00 130.64 38192.00 305.56 1400.00 2143.31 593.63 164.80 419.66 2236.20 748.20 219.11 252.00 2040.61 2201.78 501.20 13226.06 24965.94 7134.32 96 203.00 100.50 240.00 48 10.00 47.75 8

FOC PAYROLL 

124 LEROY 

ROAD 

WILLISTON VT 05495

Phone 802-657-7860

ERICA A JORDAN

3668 RAINWATER TRL

MIDLOTHIAN, TX 76065-0000

Official Pay Date 07/11/2024

FOC PAYROLL 

124 LEROY ROAD 

 

WILLISTON VT 05495

Phone 802-657-7860

Case 24-44337-mxm7 Doc 7 Filed 11/21/24 Entered 11/21/24 16:04:31 Desc Main

Document Page 7 of 14
FORM AD-334

 USDA

 (REV. 8/17) 

SOCIAL SECURITY NO. PAY PERIOD DATE MO DA YR MO DA YR P/P T&A CONTACT POINT ACCT. 

STAT. 

ORGANIZATIONAL STRUCTURE PERSNL 

OFFICE PAY PLAN GR. STEP 

SALARY RATE TYPE 

EMPL. SCD FOR LEAVE RET. DEDUCTIONS THIS APPOINTMENT STATEMENT OF EARNINGS AND LEAVE 

EARNINGS AND DEDUCTIONS 

ITEM HOURS AMOUNT 

CODE DESCRIPTION P/P YR. TO DATE P/P YR TO DATE 

YEAR TO DATE LEAVE STATUS YEAR TO DATE LEAVE STATUS PT. HRS 

UNAPP MAX. C/O TYPE ACCRUED USED BALANCE TYPE ACCRUED USED BALANCE PROJECTED 

USE OR LOSE 

CREDIT HOURS-BY PAY PERIOD ANN 

RELIGIOUS COMP-BY PAY PERIOD SICK LEAVE CATEG 

TRAVEL COMP-BY PAY PERIOD COMP 

MILITARY REMARKS 

TIME OFF AWARD 

BPAPRA COMPENSATORY 

BPAPRA OBLIGATED DEBT 

DISABLED VETERAN LEAVE 

TYPE 1ST YEAR 2ND YEAR 3RD YEAR BALANCE 

REST. ANN. LEAVE HRS. 

NAME AND ADDRESS 

AGENCY HR ADDRESS

EPP CITIZENSHIP AND IMMIGRATION SERVICES 76065 - 0000

***-**-  06/30/2024 07/13/2024 13 CI-25-0120-05-14 0008 CI-26-90-0000 1699 GS 09 04 71660.00 PA F/T 01/02/2007 3074.90 01 REGULAR TIME 72.00 861.00 2472.48 29442.42 83838387888897** 

**

**626666**757576778183 61** 61 021510114040**

**

**

SICK LEAVE OTHER LEAVE TIME OFF AWARDS   PAY PERIOD HOURS & GROSS PAY ** ** ANNUAL LEAVE RETIREMENT TSP-FERS *AMT BASED ON FIXED AMT SOCIAL SECURITY (OASDI) FEDERAL TAX EXEMPTS MJ FEGLI- COVERAGE $ $74,000 FEHBA - ENROLL CODE 252 FEHBA - ENROLL CODE 315 DENTAL PLAN VISION PLAN UNION/ASSOCIATION DUES 52 3377 TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) MEDICARE TAX WITHHELD ********** TOTAL DEDUCTIONS ********** *************** NET PAY ************** DD/EFT ROUTING NO. ******** 8.00 80.00 55.00 72.00 4.00 208.00 274.72 2747.20 21.98 100.00 154.12 37.52 11.84 186.35 58.22 16.88 18.00 157.27 36.04 798.22 1948.98 1813.10 2418.72 130.64 40939.20 327.54 1500.00 2297.43 631.15 176.64 419.66 2422.55 806.42 235.99 270.00 2040.61 2359.05 537.24 14024.28 26914.92 7134.32 104 203.00 108.50 240.00 52 10.00 51.75 8

FOC PAYROLL 

124 LEROY 

ROAD 

WILLISTON VT 05495

Phone 802-657-7860

ERICA A JORDAN

3668 RAINWATER TRL

MIDLOTHIAN, TX 76065-0000

Official Pay Date 07/25/2024

FOC PAYROLL 

124 LEROY ROAD 

 

WILLISTON VT 05495

Phone 802-657-7860

Case 24-44337-mxm7 Doc 7 Filed 11/21/24 Entered 11/21/24 16:04:31 Desc Main

Document Page 8 of 14
FORM AD-334

 USDA

 (REV. 8/17) 

SOCIAL SECURITY NO. PAY PERIOD DATE MO DA YR MO DA YR P/P T&A CONTACT POINT ACCT. 

STAT. 

ORGANIZATIONAL STRUCTURE PERSNL 

OFFICE PAY PLAN GR. STEP 

SALARY RATE TYPE 

EMPL. SCD FOR LEAVE RET. DEDUCTIONS THIS APPOINTMENT STATEMENT OF EARNINGS AND LEAVE 

EARNINGS AND DEDUCTIONS 

ITEM HOURS AMOUNT 

CODE DESCRIPTION P/P YR. TO DATE P/P YR TO DATE 

YEAR TO DATE LEAVE STATUS YEAR TO DATE LEAVE STATUS PT. HRS 

UNAPP MAX. C/O TYPE ACCRUED USED BALANCE TYPE ACCRUED USED BALANCE PROJECTED 

USE OR LOSE 

CREDIT HOURS-BY PAY PERIOD ANN 

RELIGIOUS COMP-BY PAY PERIOD SICK LEAVE CATEG 

TRAVEL COMP-BY PAY PERIOD COMP 

MILITARY REMARKS 

TIME OFF AWARD 

BPAPRA COMPENSATORY 

BPAPRA OBLIGATED DEBT 

DISABLED VETERAN LEAVE 

TYPE 1ST YEAR 2ND YEAR 3RD YEAR BALANCE 

REST. ANN. LEAVE HRS. 

NAME AND ADDRESS 

AGENCY HR ADDRESS

EPP CITIZENSHIP AND IMMIGRATION SERVICES 76065 - 0000

***-**-  07/14/2024 07/27/2024 14 CI-25-0120-05-14 0008 CI-26-90-0000 1699 GS 09 04 71660.00 PA F/T 01/02/2007 3096.88 01 REGULAR TIME 60.50 921.50 2077.57 31519.99 83838387888897** 

**

**626666**757576778183 61** 61 021510114040**

**

**

SICK LEAVE OTHER LEAVE TIME OFF AWARDS   PAY PERIOD HOURS & GROSS PAY ** ** ANNUAL LEAVE RETIREMENT TSP-FERS *AMT BASED ON FIXED AMT SOCIAL SECURITY (OASDI) FEDERAL TAX EXEMPTS MJ FEGLI- COVERAGE $ $74,000 FEHBA - ENROLL CODE 252 FEHBA - ENROLL CODE 315 DENTAL PLAN VISION PLAN UNION/ASSOCIATION DUES 52 3377 TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) MEDICARE TAX WITHHELD ********** TOTAL DEDUCTIONS ********** *************** NET PAY ************** DD/EFT ROUTING NO. ******** 19.50 80.00 74.50 72.00 4.00 208.00 669.63 2747.20 21.98 100.00 154.12 37.52 11.84 186.35 58.22 16.88 18.00 157.27 36.04 798.22 1948.98 2482.73 2418.72 130.64 43686.40 349.52 1600.00 2451.55 668.67 188.48 419.66 2608.90 864.64 252.87 288.00 2040.61 2516.32 573.28 14822.50 28863.90 7134.32 112 203.00 116.50 240.00 56 29.50 36.25 8

FOC PAYROLL 

124 LEROY 

ROAD 

WILLISTON VT 05495

Phone 802-657-7860

ERICA A JORDAN

3668 RAINWATER TRL

MIDLOTHIAN, TX 76065-0000

Official Pay Date 08/08/2024

FOC PAYROLL 

124 LEROY ROAD 

 

WILLISTON VT 05495

Phone 802-657-7860

Case 24-44337-mxm7 Doc 7 Filed 11/21/24 Entered 11/21/24 16:04:31 Desc Main

Document Page 9 of 14
FORM AD-334

 USDA

 (REV. 8/17) 

SOCIAL SECURITY NO. PAY PERIOD DATE MO DA YR MO DA YR P/P T&A CONTACT POINT ACCT. 

STAT. 

ORGANIZATIONAL STRUCTURE PERSNL 

OFFICE PAY PLAN GR. STEP 

SALARY RATE TYPE 

EMPL. SCD FOR LEAVE RET. DEDUCTIONS THIS APPOINTMENT STATEMENT OF EARNINGS AND LEAVE 

EARNINGS AND DEDUCTIONS 

ITEM HOURS AMOUNT 

CODE DESCRIPTION P/P YR. TO DATE P/P YR TO DATE 

YEAR TO DATE LEAVE STATUS YEAR TO DATE LEAVE STATUS PT. HRS 

UNAPP MAX. C/O TYPE ACCRUED USED BALANCE TYPE ACCRUED USED BALANCE PROJECTED 

USE OR LOSE 

CREDIT HOURS-BY PAY PERIOD ANN 

RELIGIOUS COMP-BY PAY PERIOD SICK LEAVE CATEG 

TRAVEL COMP-BY PAY PERIOD COMP 

MILITARY REMARKS 

TIME OFF AWARD 

BPAPRA COMPENSATORY 

BPAPRA OBLIGATED DEBT 

DISABLED VETERAN LEAVE 

TYPE 1ST YEAR 2ND YEAR 3RD YEAR BALANCE 

REST. ANN. LEAVE HRS. 

NAME AND ADDRESS 

AGENCY HR ADDRESS

EPP CITIZENSHIP AND IMMIGRATION SERVICES 76065 - 0000

***-**-  07/28/2024 08/10/2024 15 CI-25-0120-05-14 0008 CI-26-90-0000 1699 GS 09 04 71660.00 PA F/T 01/02/2007 3118.86 01 REGULAR TIME 80.00 1001.50 2747.20 34267.19 83838387888897** 

**

**626666**757576778183 61** 61 021510114040**

**

**

SICK LEAVE OTHER LEAVE TIME OFF AWARDS   PAY PERIOD HOURS & GROSS PAY ** ** ANNUAL LEAVE RETIREMENT TSP-FERS *AMT BASED ON FIXED AMT SOCIAL SECURITY (OASDI) FEDERAL TAX EXEMPTS MJ FEGLI- COVERAGE $ $74,000 FEHBA - ENROLL CODE 252 FEHBA - ENROLL CODE 315 DENTAL PLAN VISION PLAN UNION/ASSOCIATION DUES 52 3377 TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) MEDICARE TAX WITHHELD ********** TOTAL DEDUCTIONS ********** *************** NET PAY ************** DD/EFT ROUTING NO. ******** 80.00 74.50 72.00 4.00 208.00 2747.20 21.98 100.00 154.12 37.52 11.84 186.35 58.22 16.88 18.00 157.27 36.04 798.22 1948.98 2482.73 2418.72 130.64 46433.60 371.50 1700.00 2605.67 706.19 200.32 419.66 2795.25 922.86 269.75 306.00 2040.61 2673.59 609.32 15620.72 30812.88 7134.32 120 203.00 124.50 240.00 60 29.50 40.25 8

FOC PAYROLL 

124 LEROY 

ROAD 

WILLISTON VT 05495

Phone 802-657-7860

ERICA A JORDAN

3668 RAINWATER TRL

MIDLOTHIAN, TX 76065-0000

Official Pay Date 08/22/2024

FOC PAYROLL 

124 LEROY ROAD 

 

WILLISTON VT 05495

Phone 802-657-7860

Case 24-44337-mxm7 Doc 7 Filed 11/21/24 Entered 11/21/24 16:04:31 Desc Main

Document Page 10 of 14
FORM AD-334

 USDA

 (REV. 8/17) 

SOCIAL SECURITY NO. PAY PERIOD DATE MO DA YR MO DA YR P/P T&A CONTACT POINT ACCT. 

STAT. 

ORGANIZATIONAL STRUCTURE PERSNL 

OFFICE PAY PLAN GR. STEP 

SALARY RATE TYPE 

EMPL. SCD FOR LEAVE RET. DEDUCTIONS THIS APPOINTMENT STATEMENT OF EARNINGS AND LEAVE 

EARNINGS AND DEDUCTIONS 

ITEM HOURS AMOUNT 

CODE DESCRIPTION P/P YR. TO DATE P/P YR TO DATE 

YEAR TO DATE LEAVE STATUS YEAR TO DATE LEAVE STATUS PT. HRS 

UNAPP MAX. C/O TYPE ACCRUED USED BALANCE TYPE ACCRUED USED BALANCE PROJECTED 

USE OR LOSE 

CREDIT HOURS-BY PAY PERIOD ANN 

RELIGIOUS COMP-BY PAY PERIOD SICK LEAVE CATEG 

TRAVEL COMP-BY PAY PERIOD COMP 

MILITARY REMARKS 

TIME OFF AWARD 

BPAPRA COMPENSATORY 

BPAPRA OBLIGATED DEBT 

DISABLED VETERAN LEAVE 

TYPE 1ST YEAR 2ND YEAR 3RD YEAR BALANCE 

REST. ANN. LEAVE HRS. 

NAME AND ADDRESS 

AGENCY HR ADDRESS

EPP CITIZENSHIP AND IMMIGRATION SERVICES 76065 - 0000

***-**-  08/11/2024 08/24/2024 16 CI-25-0120-05-14 0008 CI-26-90-0000 1699 GS 09 04 71660.00 PA F/T 01/02/2007 3140.84 01 REGULAR TIME 80.00 1081.50 2747.20 37014.39 8383838387888897

** 

**

**61626666**7575767781 61 44 **021510114040**

**

**

ANNUAL LEAVE SICK LEAVE OTHER LEAVE TIME OFF AWARDS CASH AWARD   PAY PERIOD HOURS & GROSS PAY ** ** RETIREMENT TSP-FERS *AMT BASED ON FIXED AMT SOCIAL SECURITY (OASDI) FEDERAL TAX EXEMPTS MJ FEGLI- COVERAGE $ $74,000 FEHBA - ENROLL CODE 252 FEHBA - ENROLL CODE 315 DENTAL PLAN VISION PLAN UNION/ASSOCIATION DUES 52 3377 TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) MEDICARE TAX WITHHELD ********** TOTAL DEDUCTIONS ********** *************** NET PAY ************** DD/EFT ROUTING NO. ******** 80.00 208.00 74.50 72.00 4.00 3197.20 21.98 100.00 182.02 136.52 11.84 186.35 58.22 16.88 18.00 157.27 931.65 2265.55 42.57 450.00 7134.32 2482.73 2418.72 130.64 49630.80 393.48 1800.00 2787.69 842.71 212.16 419.66 2981.60 981.08 286.63 324.00 2040.61 2830.86 651.89 16552.37 33078.43 450.00 128 203.00 132.50 240.00 64 29.50 44.25 8

FOC PAYROLL 

124 LEROY 

ROAD 

WILLISTON VT 05495

Phone 802-657-7860

ERICA A JORDAN

3668 RAINWATER TRL

MIDLOTHIAN, TX 76065-0000

Official Pay Date 09/05/2024

FOC PAYROLL 

124 LEROY ROAD 

 

WILLISTON VT 05495

Phone 802-657-7860

Case 24-44337-mxm7 Doc 7 Filed 11/21/24 Entered 11/21/24 16:04:31 Desc Main

Document Page 11 of 14
FORM AD-334

 USDA

 (REV. 8/17) 

SOCIAL SECURITY NO. PAY PERIOD DATE MO DA YR MO DA YR P/P T&A CONTACT POINT ACCT. 

STAT. 

ORGANIZATIONAL STRUCTURE PERSNL 

OFFICE PAY PLAN GR. STEP 

SALARY RATE TYPE 

EMPL. SCD FOR LEAVE RET. DEDUCTIONS THIS APPOINTMENT STATEMENT OF EARNINGS AND LEAVE 

EARNINGS AND DEDUCTIONS 

ITEM HOURS AMOUNT 

CODE DESCRIPTION P/P YR. TO DATE P/P YR TO DATE 

YEAR TO DATE LEAVE STATUS YEAR TO DATE LEAVE STATUS PT. HRS 

UNAPP MAX. C/O TYPE ACCRUED USED BALANCE TYPE ACCRUED USED BALANCE PROJECTED 

USE OR LOSE 

CREDIT HOURS-BY PAY PERIOD ANN 

RELIGIOUS COMP-BY PAY PERIOD SICK LEAVE CATEG 

TRAVEL COMP-BY PAY PERIOD COMP 

MILITARY REMARKS 

TIME OFF AWARD 

BPAPRA COMPENSATORY 

BPAPRA OBLIGATED DEBT 

DISABLED VETERAN LEAVE 

TYPE 1ST YEAR 2ND YEAR 3RD YEAR BALANCE 

REST. ANN. LEAVE HRS. 

NAME AND ADDRESS 

AGENCY HR ADDRESS

EPP CITIZENSHIP AND IMMIGRATION SERVICES 76065 - 0000

***-**-  08/25/2024 09/07/2024 17 CI-25-0120-05-14 0008 CI-26-90-0000 1699 GS 09 04 71660.00 PA F/T 01/02/2007 3162.82 01 REGULAR TIME 62.00 1143.50 2129.08 39143.47 838383838788888897

** 

**

**61626666**7575767781 61 44 **02151011404040

**

**

**

ANNUAL LEAVE SICK LEAVE OTHER LEAVE TIME OFF AWARDS CASH AWARD   PAY PERIOD HOURS & GROSS PAY ** ** RETIREMENT TSP-FERS *AMT BASED ON FIXED AMT SOCIAL SECURITY (OASDI) FEDERAL TAX EXEMPTS MJ FEGLI- COVERAGE $ $74,000 FEHBA - ENROLL CODE 252 FEHBA - ENROLL CODE 315 DENTAL PLAN VISION PLAN UNION/ASSOCIATION DUES 52 3377 TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) MEDICARE TAX WITHHELD ********** TOTAL DEDUCTIONS ********** *************** NET PAY ************** DD/EFT ROUTING NO. ******** 10.00 8.00 80.00 208.00 84.50 80.00 4.00 343.40 274.72 2747.20 21.98 100.00 154.12 37.52 11.84 186.35 58.22 16.88 18.00 157.27 36.04 959.23 1787.97 161.01 7134.32 2826.13 2693.44 130.64 52378.00 415.46 1900.00 2941.81 880.23 224.00 419.66 3167.95 1039.30 303.51 342.00 2040.61 2988.13 161.01 687.93 17511.60 34866.40 450.00 136 203.00 140.50 240.00 68 39.50 38.25 8

FOC PAYROLL 

124 LEROY 

ROAD 

WILLISTON VT 05495

Phone 802-657-7860

ERICA A JORDAN

3668 RAINWATER TRL

MIDLOTHIAN, TX 76065-0000

Official Pay Date 09/19/2024

FOC PAYROLL 

124 LEROY ROAD 

 

WILLISTON VT 05495

Phone 802-657-7860

Case 24-44337-mxm7 Doc 7 Filed 11/21/24 Entered 11/21/24 16:04:31 Desc Main

Document Page 12 of 14
FORM AD-334

 USDA

 (REV. 8/17) 

SOCIAL SECURITY NO. PAY PERIOD DATE MO DA YR MO DA YR P/P T&A CONTACT POINT ACCT. 

STAT. 

ORGANIZATIONAL STRUCTURE PERSNL 

OFFICE PAY PLAN GR. STEP 

SALARY RATE TYPE 

EMPL. SCD FOR LEAVE RET. DEDUCTIONS THIS APPOINTMENT STATEMENT OF EARNINGS AND LEAVE 

EARNINGS AND DEDUCTIONS 

ITEM HOURS AMOUNT 

CODE DESCRIPTION P/P YR. TO DATE P/P YR TO DATE 

YEAR TO DATE LEAVE STATUS YEAR TO DATE LEAVE STATUS PT. HRS 

UNAPP MAX. C/O TYPE ACCRUED USED BALANCE TYPE ACCRUED USED BALANCE PROJECTED 

USE OR LOSE 

CREDIT HOURS-BY PAY PERIOD ANN 

RELIGIOUS COMP-BY PAY PERIOD SICK LEAVE CATEG 

TRAVEL COMP-BY PAY PERIOD COMP 

MILITARY REMARKS 

TIME OFF AWARD 

BPAPRA COMPENSATORY 

BPAPRA OBLIGATED DEBT 

DISABLED VETERAN LEAVE 

TYPE 1ST YEAR 2ND YEAR 3RD YEAR BALANCE 

REST. ANN. LEAVE HRS. 

NAME AND ADDRESS 

AGENCY HR ADDRESS

EPP CITIZENSHIP AND IMMIGRATION SERVICES 76065 - 0000

***-**-  09/08/2024 09/21/2024 18 CI-25-0120-05-14 0008 CI-26-90-0000 1699 GS 09 04 71660.00 PA F/T 01/02/2007 3184.80 01 REGULAR TIME 80.00 1223.50 2747.20 41890.67 81838383838788888897** 

**44616266**66**

75757677 61 21

**

02151011404040

**

**

**

CASH AWARD ANNUAL LEAVE SICK LEAVE OTHER LEAVE TIME OFF AWARDS OVERTIME - PREMIUM RATE   PAY PERIOD HOURS & GROSS PAY ** ** RETIREMENT TSP-FERS *AMT BASED ON FIXED AMT SOCIAL SECURITY (OASDI) FEDERAL TAX EXEMPTS MJ FEGLI- COVERAGE $ $74,000 FEHBA - ENROLL CODE 252 FEHBA - ENROLL CODE 315 DENTAL PLAN VISION PLAN UNION/ASSOCIATION DUES 52 3377 TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) MEDICARE TAX WITHHELD ********** TOTAL DEDUCTIONS ********** *************** NET PAY ************** DD/EFT ROUTING NO. ******** 100.00 20.00 208.00 84.50 80.00 4.00 20.00 3777.40 21.98 100.00 217.99 161.14 11.84 186.35 58.22 16.88 18.00 161.01 50.98 1161.66 2615.74 157.27 1030.20 450.00 7134.32 2826.13 2693.44 130.64 56155.40 437.44 2000.00 3159.80 1041.37 235.84 419.66 3354.30 1097.52 320.39 360.00 2040.61 3145.40 322.02 738.91 18673.26 37482.14 1030.20 144 203.00 148.50 240.00 72 39.50 42.25 8

FOC PAYROLL 

124 LEROY 

ROAD 

WILLISTON VT 05495

Phone 802-657-7860

ERICA A JORDAN

3668 RAINWATER TRL

MIDLOTHIAN, TX 76065-0000

Official Pay Date 10/03/2024

FOC PAYROLL 

124 LEROY ROAD 

 

WILLISTON VT 05495

Phone 802-657-7860

Case 24-44337-mxm7 Doc 7 Filed 11/21/24 Entered 11/21/24 16:04:31 Desc Main

Document Page 13 of 14
FORM AD-334

 USDA

 (REV. 8/17) 

SOCIAL SECURITY NO. PAY PERIOD DATE MO DA YR MO DA YR P/P T&A CONTACT POINT ACCT. 

STAT. 

ORGANIZATIONAL STRUCTURE PERSNL 

OFFICE PAY PLAN GR. STEP 

SALARY RATE TYPE 

EMPL. SCD FOR LEAVE RET. DEDUCTIONS THIS APPOINTMENT STATEMENT OF EARNINGS AND LEAVE 

EARNINGS AND DEDUCTIONS 

ITEM HOURS AMOUNT 

CODE DESCRIPTION P/P YR. TO DATE P/P YR TO DATE 

YEAR TO DATE LEAVE STATUS YEAR TO DATE LEAVE STATUS PT. HRS 

UNAPP MAX. C/O TYPE ACCRUED USED BALANCE TYPE ACCRUED USED BALANCE PROJECTED 

USE OR LOSE 

CREDIT HOURS-BY PAY PERIOD ANN 

RELIGIOUS COMP-BY PAY PERIOD SICK LEAVE CATEG 

TRAVEL COMP-BY PAY PERIOD COMP 

MILITARY REMARKS 

TIME OFF AWARD 

BPAPRA COMPENSATORY 

BPAPRA OBLIGATED DEBT 

DISABLED VETERAN LEAVE 

TYPE 1ST YEAR 2ND YEAR 3RD YEAR BALANCE 

REST. ANN. LEAVE HRS. 

NAME AND ADDRESS 

AGENCY HR ADDRESS

EPP CITIZENSHIP AND IMMIGRATION SERVICES 76065 - 0000

***-**-  09/22/2024 10/05/2024 19 CI-25-0120-05-14 0008 CI-26-90-0000 1699 GS 09 04 71660.00 PA F/T 01/02/2007 3206.78 01 REGULAR TIME 80.00 1303.50 2747.20 44637.87 81838383838788888897** 

**44616266**66**

75757677 61 21

**

02151011404040

**

**

**

CASH AWARD ANNUAL LEAVE SICK LEAVE OTHER LEAVE TIME OFF AWARDS OVERTIME - PREMIUM RATE   PAY PERIOD HOURS & GROSS PAY ** ** RETIREMENT TSP-FERS *AMT BASED ON FIXED AMT SOCIAL SECURITY (OASDI) FEDERAL TAX EXEMPTS MJ FEGLI- COVERAGE $ $74,000 FEHBA - ENROLL CODE 252 FEHBA - ENROLL CODE 315 DENTAL PLAN VISION PLAN UNION/ASSOCIATION DUES 52 3377 TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) TSP LOAN REPAY (FED) MEDICARE TAX WITHHELD ********** TOTAL DEDUCTIONS ********** *************** NET PAY ************** DD/EFT ROUTING NO. ******** 106.50 26.50 208.00 84.50 80.00 4.00 46.50 4112.22 21.98 100.00 238.75 201.32 11.84 186.35 58.22 16.88 18.00 161.01 55.84 1227.46 2884.76 157.27 1365.02 450.00 7134.32 2826.13 2693.44 130.64 60267.62 459.42 2100.00 3398.55 1242.69 247.68 419.66 3540.65 1155.74 337.27 378.00 2040.61 3302.67 483.03 794.75 19900.72 40366.90 2395.22 152 203.00 156.50 240.00 76 39.50 46.25 8

FOC PAYROLL 

124 LEROY 

ROAD 

WILLISTON VT 05495

Phone 802-657-7860

ERICA A JORDAN

3668 RAINWATER TRL

MIDLOTHIAN, TX 76065-0000

Official Pay Date 10/17/2024

FOC PAYROLL 

124 LEROY ROAD 

 

WILLISTON VT 05495

Phone 802-657-7860

Case 24-44337-mxm7 Doc 7 Filed 11/21/24 Entered 11/21/24 16:04:31 Desc Main

Document Page 14 of 14