PROMISSORY NOTE FOR MOVING EXPENSE ADVANCE

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.

First Name:

Middle Name:

Social Security Number:

UMID: Department:

Name (please print)

Signature of Faculty/Staﬀ Member:

University Department:

Shortcode:

Department Contact (please print):

Telephone:

Date:

Last Name:

PROMISSORY NOTE AGREEMENT

PERSONAL INFORMATION

Form HR36700 Available at: h p://www.hr.umich.edu/hrris/forms/pdfs/promnotemovexpadv.pdf

Revised 8/2014

Address:

City:

State:

Zip Code:

Yes

Check mailed to above address:

Yes

Payroll pickup:

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.

Campus Address:

Campus Zip: Campus Phone:

PROMISSORY NOTE FOR MOVING

EXPENSE ADVANCE

Do NOT Email

(Form Contains

SensiƟ ve Data)

Form

HR36700

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