Form GAO-209 "Employee Interagency Annual Leave Donation and Restoration" - Arizona

What Is Form GAO-209?

This is a legal form that was released by the Arizona Department of Administration - General Accounting Office - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2015;
  • The latest edition provided by the Arizona Department of Administration - General Accounting Office;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form GAO-209 by clicking the link below or browse more documents and templates provided by the Arizona Department of Administration - General Accounting Office.

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Download Form GAO-209 "Employee Interagency Annual Leave Donation and Restoration" - Arizona

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Employee Interagency Annual Leave Donation and Restoration
T H I S S E C T I O N T O B E C O M P L E T E D B Y D O N O R
Donor’s Name
Donor’s Employee Identification Number (EIN)
Agency
Division
Section
Unit
Donor’s Work Phone
Number of Hours to be Donated
Recipient’s Name
Recipient’s Agency/Division/Section/Unit
 I am a member of the recipient’s family; I am the recipient’s….
Spouse
Child (natural, adopted, step or foster)
Parent (natural, adopted or step)
Brother/Sister
Grandchild
Grandparent
Brother/Sister-in-law
Son/Daughter-in-law
Father/Mother-in-law
Aunt/Uncle
Niece/Nephew
Under the provisions of Personnel Rule R2-5A-B602(F), I wish to contribute the number of hours of annual leave entered above to the recipient. I understand that all unused annual leave I
have contributed to the recipient will be returned to me on a proportional basis as determined by my agency’s payroll office. By my signature as donor, I certify that my relationship to the
recipient is as indicated above. Misstatement of my relationship to the recipient may subject me to disciplinary action, up to and including separation from State employment.
Donor’s Signature
Date
T O B E C O M P L E T E D B Y T H E D O N O R ’ S
T O B E C O M P L E T E D B Y T H E R E C I P I E N T ’ S
P A Y R O L L O F F I C E
P A Y R O L L O F F I C E
T h e n u m b e r o f h o u r s s h o w n b e l o w h a s b e e n r e m o v e d f r o m t h e
T h e n u m b e r o f h o u r s s h o w n b e l o w h a s b e e n p o s t e d t o r e c i p i e n t ’ s
d o n o r ’ s a c c r u e d a n n u a l l e a v e b a l a n c e a n d i s t o b e t r a n s f e r r e d t o
d o n a t e d l e a v e b a l a n c e .
t h e d o n a t e d l e a v e b a l a n c e o f t h e r e c i p i e n t .
N u m b e r o f H o u r s D o n a t e d
D o l l a r V a l u e o f H o u r s D o n a t e d
N u m b e r o f H o u r s P o s t e d t o R e c i p i e n t
P r o c e s s e d b y
D a t e
P r o c e s s e d b y
D a t e
C o n t a c t P h o n e N u m b e r
C o n t a c t F a x N u m b e r
C o n t a c t P h o n e N u m b e r
C o n t a c t F a x N u m b e r
C o n t a c t E m a i l A d d r e s s
C o n t a c t E m a i l A d d r e s s
Communication of Previously Donated Annual Leave Status
( T h i s s e c t i o n o f t h e f o r m m u s t b e c o m p l e t e d a n d r e t u r n e d t o d o n o r ’ s p a y r o l l o f f i c e w h e n t h e r e c i p i e n t ’ s p e r i o d o f s i c k l e a v e h a s e n d e d ,
e v e n i f t h e n u m b e r o f u n u s e d h o u r s i s z e r o . )
T O B E C O M P L E T E D B Y T H E R E C I P I E N T ’ S
T O B E C O M P L E T E D B Y T H E D O N O R ’ S
P A Y R O L L O F F I C E
P A Y R O L L O F F I C E
T h e n u m b e r o f p r e v i o u s l y d o n a t e d h o u r s s h o w n b e l o w w a s n o t
T h e n u m b e r o f h o u r s s h o w n b e l o w h a s b e e n p o s t e d t o d o n o r ’ s
u s e d b y r e c i p i e n t a n d i s t o b e r e s t o r e d t o d o n o r ’ s a n n u a l l e a v e
l e a v e b a l a n c e .
b a l a n c e .
N u m b e r o f H o u r s U n u s e d
D o l l a r V a l u e o f U n u s e d H o u r s
N u m b e r o f H o u r s R e s t o r e d t o D o n o r
P r o c e s s e d b y
D a t e
P r o c e s s e d b y
D a t e
GAO-209 (03/15)
Employee Interagency Annual Leave Donation and Restoration
T H I S S E C T I O N T O B E C O M P L E T E D B Y D O N O R
Donor’s Name
Donor’s Employee Identification Number (EIN)
Agency
Division
Section
Unit
Donor’s Work Phone
Number of Hours to be Donated
Recipient’s Name
Recipient’s Agency/Division/Section/Unit
 I am a member of the recipient’s family; I am the recipient’s….
Spouse
Child (natural, adopted, step or foster)
Parent (natural, adopted or step)
Brother/Sister
Grandchild
Grandparent
Brother/Sister-in-law
Son/Daughter-in-law
Father/Mother-in-law
Aunt/Uncle
Niece/Nephew
Under the provisions of Personnel Rule R2-5A-B602(F), I wish to contribute the number of hours of annual leave entered above to the recipient. I understand that all unused annual leave I
have contributed to the recipient will be returned to me on a proportional basis as determined by my agency’s payroll office. By my signature as donor, I certify that my relationship to the
recipient is as indicated above. Misstatement of my relationship to the recipient may subject me to disciplinary action, up to and including separation from State employment.
Donor’s Signature
Date
T O B E C O M P L E T E D B Y T H E D O N O R ’ S
T O B E C O M P L E T E D B Y T H E R E C I P I E N T ’ S
P A Y R O L L O F F I C E
P A Y R O L L O F F I C E
T h e n u m b e r o f h o u r s s h o w n b e l o w h a s b e e n r e m o v e d f r o m t h e
T h e n u m b e r o f h o u r s s h o w n b e l o w h a s b e e n p o s t e d t o r e c i p i e n t ’ s
d o n o r ’ s a c c r u e d a n n u a l l e a v e b a l a n c e a n d i s t o b e t r a n s f e r r e d t o
d o n a t e d l e a v e b a l a n c e .
t h e d o n a t e d l e a v e b a l a n c e o f t h e r e c i p i e n t .
N u m b e r o f H o u r s D o n a t e d
D o l l a r V a l u e o f H o u r s D o n a t e d
N u m b e r o f H o u r s P o s t e d t o R e c i p i e n t
P r o c e s s e d b y
D a t e
P r o c e s s e d b y
D a t e
C o n t a c t P h o n e N u m b e r
C o n t a c t F a x N u m b e r
C o n t a c t P h o n e N u m b e r
C o n t a c t F a x N u m b e r
C o n t a c t E m a i l A d d r e s s
C o n t a c t E m a i l A d d r e s s
Communication of Previously Donated Annual Leave Status
( T h i s s e c t i o n o f t h e f o r m m u s t b e c o m p l e t e d a n d r e t u r n e d t o d o n o r ’ s p a y r o l l o f f i c e w h e n t h e r e c i p i e n t ’ s p e r i o d o f s i c k l e a v e h a s e n d e d ,
e v e n i f t h e n u m b e r o f u n u s e d h o u r s i s z e r o . )
T O B E C O M P L E T E D B Y T H E R E C I P I E N T ’ S
T O B E C O M P L E T E D B Y T H E D O N O R ’ S
P A Y R O L L O F F I C E
P A Y R O L L O F F I C E
T h e n u m b e r o f p r e v i o u s l y d o n a t e d h o u r s s h o w n b e l o w w a s n o t
T h e n u m b e r o f h o u r s s h o w n b e l o w h a s b e e n p o s t e d t o d o n o r ’ s
u s e d b y r e c i p i e n t a n d i s t o b e r e s t o r e d t o d o n o r ’ s a n n u a l l e a v e
l e a v e b a l a n c e .
b a l a n c e .
N u m b e r o f H o u r s U n u s e d
D o l l a r V a l u e o f U n u s e d H o u r s
N u m b e r o f H o u r s R e s t o r e d t o D o n o r
P r o c e s s e d b y
D a t e
P r o c e s s e d b y
D a t e
GAO-209 (03/15)