[LETTERHEAD]

**SAMPLE**

[DATE]


MEMORANDUM

 
TO:      Wayne F. Allen
Associate Director for
Payroll and General Services

FROM:      John Doe
Administrator
Department of Research

SUBJECT:      Payroll Promissory Note Request


This request is for a promissory note for Tom Smith, SS# 000-00-0000, because his payroll entry was submitted late for processing and did not meet the deadline. His bi-weekly salary is $1,000.00 and we are requesting 50% or $500.00. It will be paid back on November 8, 1997.

If we can be of further assistance, please advise.