NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio

Addendum C
Invoice for Special Duty Service
Company Name:
Supervisor/Contact:
Phone Number:
Fax Number:
Service Location:
Please make special duty checks payable to the officer:
Officer:
SSN:
Mailing Address:
50 Village Hall Road
PO Box 271
New Albany OH 43054
Date of Service:
Rate (per hour):
Total
Hours
Worked:
Total
Due to
Officer:
Was a cruiser used during special duty hours?: Yes* No
If yes, how many hours: _______________
*Please note - a separate invoice will be mailed by the City if a cruiser was used during special duty
Officer’s Signature
Date
PD-08-116
Revised January 10, 2011