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De Valle Co. To Dr. 0
(/)
-f
~
m
C
F or Labor done durin g the M onth of 192_ j
0
z
(/)
MONTH DAY TIME DESCRIPTION OF WORK DON E
1
2
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31 I
er da . amounti ng to <J IQL_ T O T A L
o. D as at $
I
o. Day at $ per day. amountin g to - -
Less
L ess for --
,l '
Amount due I I d
--
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A ppro\·ed by R ecei ved Payment:
D
Foreman (Sign H ere)
upt.
