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Get Certified Payroll Form (PDF) - Uc

Number Page Of 1. Employee Name, Address and Social Security Number 2. Work Class 3. Hours Worked - Day & Date 5. 4. Base Project Total Hrs. Rate 6. Project Gross 7. Fringes: Cash Approved Plans Cash & Approved Plans H&W Pens Vac App 8. Total Hours All Jobs 11. 12. 9. Total 10. Other NET Gross Taxes All Jobs Withheld Deducts Paid Other OT ST OT ST OT ST OT ST OT ST OT ST OT ST OT ST Date My signature on this form signifies that I pay, or supervise the pa.

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