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Certified Payroll Forms Indiana - Excel

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Certified Payroll Forms Indiana document sample

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									                   REPORT OF OVERTIME
                   State Form 47506 (R/10-03) /PYL 2617



Name of County                                                       County Number                                        Class Code




Name of Employee                                                                                        Social Security Number




Salary                            Pay Period


                                       Beginning:                                                               Ending:
Type of Overtime                                                     Normal Work Hours




Day of Week            Sunday         Monday            Tuesday         Wednesday         Thursday           Friday          Saturday           Total


    First                                                                                                                                           0.00
    Week

   Second                                                                                                                                           0.00
    Week

                                                       CERTIFICATION BY EMPLOYEE
   I the undersigned, certify that the above-indicated time was spent in performing required functions. I understand that my current salary will be
 converted to an hourly rate and will be used as the basis for reimbursement.

   I further certify that the work I perform on this activity was done at a time other than during the regular working hours of the Indiana State
 Division of Family and Children.

Date signed (month, day, year)                                       Signature of Employee




                                                     CERTIFICATION BY SUPERVISOR
 Approved and certified as true and correct to the best of my knowledge and belief.
Date signed (month, day, year)                                    Signature of Supervisor




                                 CERTIFICATION BY COUNTY DIRECTOR / SECTION DIRECTOR
 Approved and certified as true and correct to the best of my knowledge and belief.
Date signed (month, day, year)                                    Signature of County Director / Section Director




NOTICE OF REQUIREMENTS: All details must be completed as state so that proper payment may be made to the employee in a timely manner.
FAILURE to properly complete this form will result in a NON-PAYMENT and return of this form tom the LOCAL PAYROLL CLERKS for corrections.

								
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