Payroll adjustment form with signatures, 2001

z z THE CITY OF NEW YORK -< o PAYROLL MANAGEMENT SYSTEM EMPLOYEE TIME REPORT SS

I o FISA FORM ADJUSTMENT -□ c CT o'

□ DOCUMENT NO. SOCIAL SECURITY NO. CD JSN WORK UNIT "0

Enrn o o tn CD o o 2 fejoldol ;q. 03 o o> o

□ LAST NAME RRST M o c IpElolcIhl-VUalnl I I I I I I idrbill I I I I I I I I I 3 o 3

r ] AGENCY ENTRY TYRE EVENT DATC czzn I OAT I I TEAR I I j [ ENTRY TYPE EVENT Ting :l MW J I REPORTING CATEGt»Y 1 El SALAWOIFF. 00 ARS J ] [ SUPPL PATINO

"S lolaJ lihl loliJ ESEH mEB [ in ELI □u □ T 1 l60hk>im Mablol [31Lm [ ED ELL I nn □ loblbJaJkdiJ EEHsl 03^ [ □ [ □j UI DO I NEW ] lo0KWHorn k lalalol ESH0 I □I rn ELI on ^1 OLD ] bElaEUJ ESEH 0aFE0 I ED EJI Lin NEW ] Iol°lll3lollolil k bblot 03£E [ m Eu on Bal 121a) Hd EMS [I®@3 I m EI I new I lohllalalblil h laMol h fellolol [ m Eu mn

PREPARER MANAGER/SUPERVISOR KEY ENTRY OPERATOR ‘ I CERTIFY THAT THE AF«E I CERTIFY THAT I HAVE REVIEWED THE ABOVE 1 CERTIFY THAT THE ABOVE DATE WAS ENTERED SUPPORTED BY ON ADJUSTMENT TRANSACTIN' INTOPMS

StCWATURfX^ SIQNATIWE y SJQNATURE

DATE ^7 OATS DATE