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CITY OF BELGRADE 91 E. CENTRAL BELGRADE, MT 59714 www.ci.belgrade.mt.us Phone: [PHONE REDACTED] Fax: [PHONE REDACTED] Advance Mid Month Pay Request The pay date for the City of Belgrade is the 30th of each month. You may sign up for an optional mid- month draw check, which is processed on or around the 15th of each month. The amount of the Advance Mid Month Pay Check must be less than ½ of your Net (take-home) Pay for the month. Employee Name (printed): Please mark one of the options below to indicate whether or not you want to receive an Advance Mid Month Pay Check on the 15th of each month. NO, do not process an Advance Mid Month Pay Request. □ Cancel Advance Mid Month Pay: Effective Date: YES, I authorize the City to process a Advance Mid Month Pay Check: Effective Date: □ In the Amount of (not to exceed ½ of my Net Pay): □ Change Amount from to Note: The Mid Month Pay Request will be administered in check form. Mid Month Pay is not eligible for direct deposit. Checks will be located in Payroll at City Hall. Employee’s Signature: Date Signed: