Jury Duty - cert by slappypappy116

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									                             LEMON GROVE SCHOOL DISTRICT

                         CERTIFICATED JURY REIMBURSEMENT FORM


Name: _____________________________ SS#: ________________________

I have postponed my original jury service to: ____________________________

Date(s) originally requested to serve: __________________________________
Attach original request to time sheet.

Date(s) actually served: _____________________________________________
Attach time sheets from the jury.

_______________________________            __________________________
Teacher Signature                          Date

_______________________________            __________________________
Administrator Signature                    Date

Please send to Payroll




11/97                                                                        HR Form 100

								
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