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Del Valle Co. To Dr.
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For Labor done during the Month of 192_ j
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(/)
MONTH DAY TIME DESCRIPTION OF WORK DONE
1
2
')
~1
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( ~ per dt1 v, amountin g to fu(,, \ .s-c TOTAL
o. Days at $
\
No. Days at $ per day. amounting to I --
Less
L ess for
--
toe d
Amount due I
A ppro,·ed by Rect!i ,·ed Payment:
F oreman ( ign Here)
upt.
