Box 22, Folder 2, Document 29

Box 22, Folder 2, Document 29

DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT rea

REQUEST FOR COMPENSATION FOR PER DIEM PERSONNEL

(Subnit original only at close of pay period)















TO: DIVISION OF FINANCE AND ACCOUNTS Date 11/20/66
FROM: Office of Secretary
(Office or Division) (Branch)

empLoyer: ___-van Allen Jr, TITLE: Consultant
EMPLOYED BY:

Appointment effective 10/27/66

or

Contract effective
Per diem salary $ 100.00
Pay period: From: 420 to 12/3/66 , 19 incl.



HOURS WORKED
DATE

DAY SUN mon | TUES | WED | THURS] FRI SAT SUN MON | TUES | weD | THURS| FRI
HOURS



I certify that I have performed services under the above listed appointment or
contract for the hours indicated.



(Signature of Enaployee)

I certify that the employee named herein performed services for the hours in-
dicated and request that he be compensated therefor in accordance with the terms of

his appointment or contract.





(Title of Supervising Officer) (Signature)





FOR USE BY PAYROLL SECTION