Authorization to collect wages

(1)

AUTHORIZATION TO COLLECT WAGES (Head of the Family Unit)

DATE~

-

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FARM IDENTIFICATION _ _ _ _

F.ach

~-:::.dersigned

hereby appoints_f/w."-lf L trA

:<3uo

as his agent

{Family Heaff

with authority on behalf of the undersigned to collect, receive, and

acknow-_,,__ _ _ _ .ledge---rec~:Lpt--0£ wages stated n wage record shee·ts or other records as earned by each of the undersigned for work performed in the production, cultivation, or harvesting of the 19~ crop of sugarbeets produced on the farm of

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Name of Worker

(Print)

A-N"1e.L.L

rtl_L29M

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y_

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£,,,l.~t.:4~~~~~~2:2.a~-/J.1Ld Vt o

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HEAD OF FAMILY CERTIFICATION

I have ~ceived payment in full for the workers at the rate of

S

J.-o ~ per acre for

J.o.

l.(a acres for _ _ __...r:.:.~---~---~

1 J.l

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7 Jo,? l " ,_..,

t.J"U~

o work done

Total Due$

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Dates work. performed_

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of Head of Family}

NorE~

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cel'tifi(;ttion may only be used for piecework with

no

hourly guarantee. If work is performed by the hour or on a piecework basis with minimum

hourly guarantee wage records MUST be kept for each worker. INSTRUCTIONS: Prepare this form in two (2) copies.

'and one for the head of the familyo available at the County ASCS Officeo

One for the farm operator Additional copies are