Fillable Form Hr36700 - Promissory Note For Moving Expense Advance printable pdf download

PROMISSORY NOTE FOR MOVING

Form

HR36700

EXPENSE ADVANCE

(Form Contains

Do NOT Email

Sensi ve Data)

Original, completed and signed Request for Moving and Reloca on Advance (PeoplePay form) must be a ached.

PERSONAL INFORMATION

First Name:

Middle Name:

Last Name:

UMID:

Department:

Social Security Number:

PROMISSORY NOTE AGREEMENT

In considera on of the advance to me for moving expenses by the University of Michigan in the sum of

_____________________________________________________ Dollars ($________________)

To facilitate my employment with the University, I ________________________________________ hereby promise to pay to the order

of The Regents of the University of Michigan, a Michigan cons tu onal corpora on, any por on of such advance which is not u lized

for moving expenses, as approved by the University, or which is not substan ated with appropriate receipts within 90 days from the

signature date of this Promissory Note.

To the extent that such a por on exists, I authorize the University Payroll Oﬃ ce to deduct the full amount thereof from my ﬁ rst

regularly scheduled paycheck a er the 90-day period from the signature date of the Promissory Note. If it is necessary to deduct the

amount over several paychecks to comply with the State of Michigan regula ons, I authorize the University Payroll Oﬃ ce to deduct

equal installments un l the full amount is recovered.

Name (please print)

Signature of Faculty/Staﬀ Member:

Date:

State:

Address:

City:

Zip Code:

Yes

Check mailed to above address:

Payroll pickup:

Yes

Shortcode:

University Department:

Campus Address:

Campus Zip:

Campus Phone:

Department Contact (please print):

Telephone:

INSTRUCTIONS FOR COMPLETING THE PROMISSORY NOTE

Standard Prac ce Guide for reference:

SPG 201.68 – Moving and Reloca on Expenses (h p://spg.umich.edu/pdf/201.68.pdf)

Related Forms:

Request for Moving and Reloca on Advance Form – PeoplePay

Reimbursement/Reconcilia on of Moving and Reloca on Expenses Form – PeoplePay

Guidelines for using this form:

Department Administrator: Send PDF ﬁ le or the form’s URL to faculty/staﬀ member reques ng advance. Provide faculty/staﬀ member

with the address to which they return the form. When signed form is returned, complete Request for Moving and Reloca on Advance

form. Send original copy of Promissory Note, plus one copy, along with the approved request form to SSC HR, Wolverine Tower,

3003 South State Street, Ann Arbor, MI 48109-1276.

Faculty/Staﬀ Member: Complete the name and address ﬁ elds on the Promissory Note and mail it, along with a wri en es mate of your

moving costs, to the address provided by the department administrator. Use your legal name in the name ﬁ elds. Save all receipts related

to the move. Original receipts should be submi ed to the department administrator to be reconciled with the advance.

Form HR36700

Revised 8/2014

Available at: h p://

Form Hr36700 - Promissory Note For Moving Expense Advance

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