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De Valle Co.
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ID
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For Labor done during the Month of----=--=----==------.:'---------'-------192L 5
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=======i===--:i====----i=====-=-=========----:::=====~- --=-=-:-=_::-:_==--::--:::===========I====
MONTH DAY TIME DESCRIPTION OF WORK DONE
1
2
,,
,)
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21 , I
22
23
24
25
26
27
28
29
30 .,
I,
31
TOTAL
,No. Days at $ per da y, amounting to
)
o. Days at $ per day, am ounting to i _.;;.;;__
Less
L ess for
/
Am.ount due
-
Approved by R eceived Payment:
(Sign Here) _____________ --1-
