PAYROLL BILLING FORMS

Name & School of Person

ACCOUNT #

Dates & Description of Services:

BILL FORMS MUST BE RECEIVED BY THE PAYROLL DEPARTMENT NO LATER THAN THE FIRST DAY OF THE MONTH IN WHICH PAYMENT IS TO BE MADE.

Amount of

Rendering Service:	(Show calculation where applicable)	Payment

I hereby certify that I have rendered the services stated herein, and that the amount of payment is justly due and payable to me.

Date	Signature of Person Rendering Service

PAYMENT AUTHORIZATION: (All sections below must be completed by the Administrator in Charge Before payment can be made)

Please check: Single Full Payment -	Partial Payment -

A. General Authorization: (Payment is made in accordance with approved salary rate schedule) Please check: Part Time Work -	Substitute -	Overtime -

B. Special Authorization: (Payment is made in accordance with specific BOARD APPROVAL) Please check: Athletics -	Clubs -	Workshop -	Other -

Please complete: BOARD MEETING DATE:	(MANDATORY)

AMOUNT OF BOARD AUTHORIZATION:

I hereby certify that the amount authorized for payment is justly due and owed for services rendered as indicated and payment is approved.

Date	Signature of Administrator in Charge

Date	Signature of Asst. Supt. of C & I (REQUIRED B PAYMENT)

NOTE: If any of the information necessary to process this payment is omitted, this bill form will be returned and payment may be delayed.