Example payroll deduction authorization form
[DOCX File]Microsoft Word - 2012 Payroll Deduction Authorization form
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2014 Payroll Deduction Authorization for Health Savings Account . You may have your employer deduct your HSA contribution from your pay. Before deciding on the amount to be withheld each pay period: Review the annual contribution limits that fit your insurance coverage (Single or Family). The . 2014. tax year limits are as follows: Single coverage
[DOC File]Repayment Agreement-draft
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Authorization. I authorize each and every payroll deduction as delineated in the above schedule. Furthermore, should my employment at the University of Michigan end prior to the completion of the Repayment Schedule, I authorize a maximum payroll deduction allowed by law to be withheld from my final paycheck. I also agree to repay the University ...
[DOC File]Sample Letter - Notification of Payroll Overpayment ...
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AUTHORIZATION FOR PAYROLL DEDUCTION: I agree with the . Statement of Facts . section above and agree to repay the agency with cash or personal check or authorize deduction of the amount as shown below from my payroll payment(s) in order to satisfy my overpayment. ( Please accept cash/personal check for the overpayment.
SAMPLE Payroll Deduction Authorization LETTER
SAMPLE Payroll Deduction Authorization LETTER ... Please return your completed form to _____ [Accounting/HR Department]. Contributions are not deductible for Federal income tax purposes. Contributions to NECAPAC are voluntary and are used for political purposes. You may refuse to contribute without reprisal.
[DOC File]Payroll Deduction Authorization - TN
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Payroll Deduction Authorization. Employee Name: Social Security Number: --Position Number: I hereby acknowledge that I have received State funds and/or property and I am obligated to return the funds and/or property at the request of my agency or upon my termination from State government. I understand that the State funds and/or property are ...
[DOC File]Employee Notification of Payroll Deduction
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This memorandum serves as notification of a payroll deduction from your paycheck due to the outstanding debt owed the State of Tennessee for failure to return the property within three business days. The total debt owed will be $.
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