Final Paycheck Acknowledgment Temp

							                             Final Paycheck Acknowledgment

I , (the undersigned recipient), have received my final paycheck from

(Company Name)

The total amount of the paycheck is:


The paycheck amount represents:


             Wages
             Accrued Vacation Pay
             Other




             Deductions




To the best of my knowledge, there is no additional money owed to me by the employer at the
present time.



Name of the Recipient



Signature of the Recipient                                        Date




Signature of the Person Issuing the Final Paycheck                Date