7-4 Pay end date Enter period end date of pay. 7-5 Monthly salary Enter monthly salary to be paid. If changes in distribution occur during appointment period, provide both the current distribution and the new distribution. Enter any other comments that may be pertinent to this award. Signatures and Dates Forms should be signed and dated by the appropriate person in the blocks indicated.
Date is the date of actual signature.
11-1 Prepared by Enter name of person that prepared form, phone number and date form was prepared.