How to write the certificate of slowing down the application fee for design patent?

Personal:

profit and loss statement

Zhang San, ID number,128082391208309; For our employees.

The annual income is 35,000.

This is to certify that.

Work unit:

201may 9, 7

Print it out and stamp it at the back of the work unit. If the annual income is less than 42,000, it will be delayed.