Employee Time Report Form, DEP Box 32, Dec 1994

NYC 9/11 Public Portal Document

THE CITY OF NEW YORK PAYROLL MANAGEMENT SYSTEM EMPLOYEE TIME REPORT FISA FORM PMSF 13(12ZM) ADJUSTMENT □ DOCUMENT NO.

LAST NAME SOCIAL SECURITY NO.

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SBIpS Uck>iri?idi°i 1111 II J bblsklplhl I I I I 1 ENTRY I I EVENT PATE U I ENTRY EVENT TIME 1 AGENCY REPORTING smarypiff. I I SUPPL TYPE I [ MONTH f I PAY I I YEAR~1 | TYPE HOURS I :| MIN I DATA I CATEGORY DOLLARS 1 I CENTS | | PAY IND

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PREPARER MANAGER/SUPERVISOR KEY ENTRY OPERATOR 1 CERTIFY THAT THE ADJUSTMENiSARE I CERTIFY THAT I HAVE REVIEWED THE ABOVE I CERTIFY THAT THE ABOVE DATE WAS ENTERED SUPPORTED BY DOC ATIQXl ON FILE ADJUSTMENT TRANSACTION INTOPMS

SIGNATURE * zTTZ SIGNATURE , . / F SIGNATURE

DATE DATE □ATE

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