Payroll Handcheck Requisition

Check Amount $ ________________________

Date _____________

Make check payable to: ___________________________

__________________________________________________

__________________________________________________

Reason for hand check: __________________________

__________________________________________________

__________________________________________________

Hours ____________._____

Rate ____________._____

Gross Wage ____________._____

Federal ____________._____

State ____________._____

FICA ____________._____

Local ____________._____

Medicare Tax ____________._____

___________ ____________._____

Paycheck $____________._____

Requested by ____________________

Authorized by ____________________

Contract law requirements

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