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					OVERTIME PAY REQUEST FORM                                                                                                     ACTIVITY CODE


CASE NAME/OR NUMBER:                    District 3                              CYCLE #
                                                                                                                               62881
FUNDING SOURCE:                  DUI Abatement 10-032                                                FOR DIVISION USE ONLY
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COMPLETED BY:                               Ext.                                                      |                 |


                                                                 O/T HOURS EARNED THIS CYCLE                                   FOR DIVISION
                                                   WEEK ENDING    WEEK ENDING    WEEK ENDING     WEEK ENDING                    USE ONLY
                                                                                                                 TOTAL O/T
                      OFFICER                        /    /          /   /          /     /          /   /         HOURS       (DO NOT ENTER
                                                                                                                EARNED THIS    ANYTHING INTO
 BADGE       (Please list in badge order)            WK #1           WK #2          WK #3            WK #4         CYCLE        THIS COLUMN)

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                                                                                              GRAND TOTAL               -

APPROVED BY:




Supervisor                                  Date                                Bureau Commander                              Date




District Commander                          Date                                Division Commander                            Date
                                                                                                                                     Revised 7/2009

				
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posted:8/25/2011
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