Salary Disclosure

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					                                                      RECORD OF EMPLOYEES' 2009 SALARIES AND BENEFITS
                                      Please refer to the guide Preparing Your Report for the Year 2009, Public Sector Salary Disclosure before filling out this form




 Cal Year         Sector            Employer                  Surname               Given Name                                          Position                        Salary Paid   Taxable Benefits
                                                                               Insert additional rows at the end as needed

   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00
   2009                                                                                                                                                                                        $0.00



This record has been approved by:


Name                                                                                                Position Title



Phone Number                                                                                        Date

                                                                   Prepared under the Public Sector Salary Disclosure Act, 1996




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