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Employee Award or
Prize Acknowledgement
State of Oklahoma
Office of Management
& Enterprise Services
Human Capital Management
Date Received:
Name of Recipient: Employee ID:
Description of Award or Prize:
Fair Market Value:
I hereby acknowledge receipt of the award or prize described above. I further acknowledge that the
fair market value of the award or prize is taxable and will be reported to OMES Payroll for processing
through payroll as required by law.
Signature of Recipient
Signature of Division Representative
OMES - FORM HCM 004 (2014) PAGE 1 OF 1