P THE CITY OF NEW YORK OFFICE OF THE

 JULY 15 2015 THE HONORABLE NATHAN DEAL OFFICE
 UNITED NATIONS OFFICE OF LEGAL AFFAIRS ANNOUNCEMENT FOR
EXECUTIVE OFFICEDIVISION NAME BUREAUDISTRICT OR SECTION NAME PO

RESEARCH REPORT  CORRECTIONAL OFFICER RECRUITS AND THE
0 UNITED NATIONS OFFICE AT VIENNA OFFICE
087 REVEREND FATHER WORTHY OFFICERS MY BROTHER KNIGHTS

Contractor's/Subcontractor's Payroll Report (page 1 of 2)

P

THE CITY OF NEW YORK

OFFICE OF THE COMPTROLLER

DIVISION OF LABOR LAW

AGENCY


DEPT. OF DESIGN AND CONSTRUCTION

 P THE CITY OF NEW YORK OFFICE OF THE P THE CITY OF NEW YORK OFFICE OF THE AYROLL REPORT


(TO BE SUBMITTED WITH REQUISITION FOR PAYMENT)


NAME OF CONTRACTOR/SUBCONTRACTOR




ADDRESS











PHONE No.

PAYROLL No.

CONTRACT REG. No.

JOB CODE

WEEK ENDING - DATE

PROJECT NAME & LOCATION

TAX I.D. No.

(1)

(2) LIST TRADE

(3)

(4)



DAY AND DATE




(5)

(6)

(7)

SUPPLEMENTAL BENEFITS

(11)

(12)

(13)

NAME,

& CIRCLE WORK









TOTAL

BASE

TOTAL


(9)





ADDRESS,

CLASSIF:

TIME








HOURS

RATE OF

BASE

(8)

PAID TO

(10)

GROSS

TOTAL TAX

NET

SOCIAL SECURITY No.

JOURNEYPERSON










PAY PER

PAY

RATE

(Local # if

TOTAL

PAY

& OTHER

PAY


APPRENTICE










HOUR


PER

Union is

PAID


DEDUCTIONS



HELPER





HOURS WORKED EACH DAY






HOUR

Checked)

























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(INSTRUCTIONS ON REVERSE SIDE)


FALSIFICATION OF STATEMENT IS A PUNISHABLE OFFENSE

I hereby certify that the above information represents wages and supplemental benefits paid to all persons employed by my firm for construction work upon the above project during the period shown.

I understand that the Agency relies upon the information as being complete and accurate in making payments to the undersigned.

___________________________________________ ___________________________________________ ______________________________________ _____________________________

SIGNATURE NAME (Print) TITLE DATE

Rev. 03/97


11 STATUTS TYPE SÀRL OFFICE FÉDÉRAL
2 UNITED NATIONS OFFICE AT VIENNA OFFICE
3 FOR OFFICE USE FEE RECEIVED £


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