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DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT rea
REQUEST FOR COMPENSATION FOR PER DIEM PERSONNEL
(Submit 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)
empLoyee: ‘van Allen dr 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