Payroll Information: Child Care

St. Andrews Episcopal Church o 406 Hillsboro Avenue o Edwardsville, Illinois 62025

Payroll for the month of ___________________________________________________

Child Care provider’s name:_________________________________________________

Child Care provider’s Social Security #:_______________________________________

Child Care provider’s street, city, state, zip:

_______________________________________________________________________

(If provider is new)

Dates worked:

Sunday, _____________________ @ $25.00 $ 25.00__________

Sunday, _____________________ @ $_____ $_______________

Other _______________________ @ $10 per HR $_______________

TOTAL $_______________

Supervisor’s Signature affirming the accuracy of this information:

_______________________________________________________________________

Reporting: This form should be completed and given to Cindy Yelverton, Assistant Treasurer, or put in the Assistant Treasurer’s church mailbox prior to or on the last Sunday of the payroll period month.

Pay Checks: A check will be mailed to the child care provider no later than the tenth day of the month following the end of the prior payroll month.

Office Use Only:

Date Paid:_____________________ Transaction No.:___________________________

Paid By:_______________________