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DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Mera
REQUEST FOR COMPENSATION FOR PER DIEM PERSONNEL
(Submit original only at close of pay period)
11/7/66
TO: DIVISION OF FINANCE AND ACCOUNTS Date
FROM: Office of Secretary
(Office or Division) (i eeRI
EMPLOYEE: Ivan Allen TITLE: Consultant
EMPLOYED BY:
Appointment effective
or Mage pt DS aplet ape a
Contract effective
Per diem salary $ 190,00
er
Pay period: - from: =. 49/6/46... to 11/19/66 19 incl.
HOURS WORKED
DATE
DAY es | wep | THURS| FRI SAT ES | WED | THURS| FRI
HOURS
I certify that I have performed services under the above listed appointment or
contract for the hours indicated.
(Signature of Employee)
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,
Administrative Officer
(Title of Supervising Officer) (Signature)
FOR USE BY PAYROLL SECTION