ContractPayroll Deduction Agreement • November 30th, 2016
Form 2159(Rev. January 2007) Department of the Treasury — Internal Revenue ServicePayroll Deduction Agreement(See Instructions on the back of this page.) TO: (Employer name and address) Regarding: (Taxpayer name and address) Contact Person’s Name Telephone (Include area code) Social security or employer identification number(Taxpayer) (Spouse) EMPLOYER—See the instructions on the back of Part 2. The taxpayer identified above on the right named you as an employer. Please read and sign the following statement to agree to withhold amount(s) from the taxpayer’s (employee’s) wages or salary to apply to taxes owed.I agree to participate in this payroll deduction agreement and will withhold the amount shown below from each wage or salary payment due this employee. I will send the money to the Internal Revenue Service every: (Check one box.) Your telephone number (Include area code)(Home) (Work or business) For assistance, call: 1-800-829-0115 (Business) or1-800-829-8374 (Individual – Self-E
PAYROLL DEDUCTION AGREEMENT FOR VOLUNTARY EMPLOYEE PAID PROGRAMSPayroll Deduction Agreement • December 17th, 2018
PAYROLL DEDUCTION AGREEMENTPayroll Deduction Agreement • September 15th, 2020
AGUSM PAYROLL DEDUCTION AGREEMENTPayroll Deduction Agreement • January 3rd, 2020
ContractPayroll Deduction Agreement • July 5th, 2017
Form 2159(November 2016) Department of the Treasury — Internal Revenue ServicePayroll Deduction Agreement(See Instructions on the back of this page.) TO: (Employer name and address) Regarding: (Taxpayer name and address) Contact Person’s Name Telephone (Include area code) Social security or employer identification number(Taxpayer) (Spouse, last four digits) EMPLOYER — See the instructions on the back of Part 2. The taxpayer identified above on the right named you as an employer. Please read and sign the following statement to agree to withhold amount(s) from the taxpayer’s (employee’s) wages or salary to apply to taxes owed.I agree to participate in this payroll deduction agreement and will withhold the amount shown below from each wage or salary payment due this employee. I will send the money to the Internal Revenue Service every: (Check one box.)WEEK TWO WEEKS MONTH OTHER (Specify.)Signed: Title: Date: Your telephone number (Include area code)(Home) (Work or business) For assistance
ContractPayroll Deduction Agreement • February 8th, 2016
Form 2159(Rev. January 2015) Department of the Treasury — Internal Revenue ServicePayroll Deduction Agreement(See Instructions on the back of this page.) TO: (Employer name and address) Regarding: (Taxpayer name and address) Contact Person’s Name Telephone (Include area code) Social security or employer identification number(Taxpayer) (Spouse, last four digits) EMPLOYER — See the instructions on the back of Part 2. The taxpayer identified above Your telephone number (Include area code) on the right named you as an employer. Please read and sign the following statement toagree to withhold amount(s) from the taxpayer’s (employee’s) wages or salary to apply to (Home) (Work or business) taxes owed. For assistance, call: 1-800-829-0115 (Business) or1-800-829-8374 (Individual – Self-Employed/Business Owners), or1-800-829-0922 (Individuals – Wage Earners) Or write: Campus(City, State, and ZIP Code) I agree to participate in this payroll deduction agreement and will withhold the amount shown
PAYROLL DEDUCTION AGREEMENTPayroll Deduction Agreement • December 11th, 2019
This Agreement is legally binding and irrevocable for both the Institution and the Employee while employment continues. However, either party may terminate this Agreement as of the end of any month (or pay period, if applicable) by giving at least 30 days’ written notice. The Agreement will not apply to salary earned after the agreement is terminated.
ContractPayroll Deduction Agreement • July 3rd, 2018
Form 2159(July 2018) Department of the Treasury — Internal Revenue ServicePayroll Deduction Agreement(See Instructions on the back of this page.) TO: (Employer name and address) Regarding: (Taxpayer name and address) Contact Person’s Name Telephone (Include area code) Social security or employer identification number(Taxpayer) (Spouse, last four digits) EMPLOYER — See the instructions on the back of Part 2. The taxpayer identified above on the right named you as an employer. Please read and sign the following statement to agree to withhold amount(s) from the taxpayer’s (employee’s) wages or salary to apply to taxes owed.I agree to participate in this payroll deduction agreement and will withhold the amount shown below from each wage or salary payment due this employee. I will send the money to the Internal Revenue Service every: (Check one box.)WEEK TWO WEEKS MONTH OTHER (Specify.)Signed: Title: Date: Debit Payments Self-IdentifierIf you are unable to make electronic payments through a
Payroll deduction agreementPayroll Deduction Agreement • April 15th, 2013
Valdosta State University Payroll Deduction Agreement FormPayroll Deduction Agreement • June 2nd, 2015
This agreement is made between employee named above and Valdosta State University. Both parties agree that your employer will remit the contribution amount indicated below per pay period (10 for academic faculty, 12 for monthly, 24 for biweekly). Your employer will send your contributions to the company (ies) you have selected below in accordance Internal Revenue Code regulations. Employee must submit an application directly to the vendor selected before payroll deduction can begin.
Payroll Deduction Agreement - Spring SemesterPayroll Deduction Agreement • November 30th, 2018
Add-ons (Circle One per Member) ***Length of service must be the same as membership length. ***: Locker Service F/S Mem: No Locker 2 Sem Full $55 2 Sem Top $35 2 Sem Bottom$30 1 Sem Full $45 1 Sem Top $25 1 Sem Bottom$20 Mem 2: No Locker 2 Sem Full $55 2 Sem Top $35 2 Sem Bottom$30 1 Sem Full $45 1 Sem Top $25 1 Sem Bottom$20 Mem 3: No Locker 2 Sem Full $55 2 Sem Top $35 2 Sem Bottom$30 1 Sem Full $45 1 Sem Top $25 1 Sem Bottom$20 Mem 4: No Locker 2 Sem Full $55 2 Sem Top $35 2 Sem Bottom$30 1 Sem Full $45 1 Sem Top $25 1 Sem Bottom$20 Towel Servi ce F/S Mem: No Towel Service 2 Semester $20 1 Semester $10 Mem 2: No Towel Service 2 Semester $20 1 Semester $10 Mem 3: No Towel Service 2 Semester $20 1 Semester $10 Mem 4: No Towel Service 2 Semester $20 1 Semester $10
PAYROLL DEDUCTION AGREEMENT FORMPayroll Deduction Agreement • August 10th, 2020
Payroll Deduction Agreement - Fall SemesterPayroll Deduction Agreement • August 16th, 2019
Add-ons (Circle One per Member) ***Length of service must be the same as membership length.***: Locker Service F/S Mem: No Locker Annual Full$65 Annual Top$45 AnnualBottom $40 2 Sem Full $55 2 Sem Top $35 2 Sem Bottom$30 1 Sem Full $45 1 Sem Top $25 1 Sem Bottom$20 Mem 2: No Locker Annual Full$65 Annual Top$45 AnnualBottom $40 2 Sem Full $55 2 Sem Top $35 2 Sem Bottom$30 1 Sem Full $45 1 Sem Top $25 1 Sem Bottom$20 Mem 3: No Locker Annual Full$65 Annual Top$45 AnnualBottom $40 2 Sem Full $55 2 Sem Top $35 2 Sem Bottom$30 1 Sem Full $45 1 Sem Top $25 1 Sem Bottom$20 Mem 4: No Locker Annual Full$65 Annual Top$45 AnnualBottom $40 2 Sem Full $55 2 Sem Top $35 2 Sem Bottom$30 1 Sem Full $45 1 Sem Top $25 1 Sem Bottom$20 Towel Service F/S Mem: No Towel Service Annual $30 2 Semester $20 1 Semester $10 Mem 2: No Towel Service Annual $30 2 Semester $20 1 Semester $10 Mem 3: No Towel Service Annual $30 2 Semester $20 1 Semester $10 Mem 4: No Towel Service Annual $30 2 Semes
Payroll Deduction AgreementPayroll Deduction Agreement • January 9th, 2014
Together We Make A DifferencePayroll Deduction Agreement • August 27th, 2013
Alvin ISD Education Foundation Payroll Deduction Agreement (Please return to your campus secretary or to the foundation)
ContractPayroll Deduction Agreement • December 13th, 2019
UTHealth Mobility ProgramPAYROLL DEDUCTION AGREEMENT (including subsidy) The University of Texas Health Science Center at Houston (UTHealth) Mobility Program enables employees to pay for approved commuting expenses with pre-tax dollars taken directly from their paychecks (pursuant to the provisions of the Internal Revenue Code for Qualified Transportation Benefits). This form is for enrolling in or dropping from the program. Payroll deductions for the Mobility Program are made one full month in advance. That is, payroll deductions taken in one month (for example, April) are applied to commuting expenses in the following month (May). This form must be received by the 5th day of the month for your participation to be activated or discontinued in the following month.
Valdosta State University Payroll Deduction Agreement FormPayroll Deduction Agreement • June 2nd, 2015
This agreement is made between employee named above and Valdosta State University. Both parties agree that your employer will remit the contribution amount indicated below per pay period (10 for academic faculty, 12 for monthly, 24 for biweekly). Your employer will send your contributions to the company (ies) you have selected below in accordance Internal Revenue Code regulations. Employee must submit an application directly to the vendor selected before payroll deduction can begin.
PAYROLL DEDUCTION AGREEMENTPayroll Deduction Agreement • June 24th, 2020
I hereby authorize the University of North Texas Payroll Office to deduct a monthly fee from my check to pay for my Pohl Recreation Center membership and/or locker and/or towel service. In order to cancel the deduction, I understand that I will need to contact the Recreational Sports Office (Pohl Rec Center, Room 103) to sign the appropriate forms to stop my membership and/or locker and/or towel service. I understand that cancellation of the deduction will go into effect the month after my completing all of the necessary steps with the Recreational Sports Office. I understand that I must cancel the deduction through the Recreational Sports Office by the 10th of the month prior in order to have the deduction stopped by the next pay period. Deductions will only be taken for those months designated above.
PAYROLL DEDUCTION AGREEMENT 2016-2017Payroll Deduction Agreement • August 23rd, 2016
Print PagePayroll Deduction Agreement • December 7th, 2009
Date Employee or Student’s Name (Please print) Banner ID Deduction Codes (DC) Accounts Receivable (Undergrads & Employees ONLY) Payroll DC# 506 Summer 507 Fall 505 Spring Graduate Payroll Deduction (Grads ONLY) Payroll DC# 521 Summer 522 Fall 520 Spring Agreement By signing below, I acknowledge and agree that installments of $ will be deducted each pay period for a grand total of $ and applied towards DC# designated. Employee or Student Signature Date BUSINESS OFFICE USE ONLY Students Acct’s Signature Date Payroll Deduction Cancellation Date (signature or authorization-i.e. phone)
ContractPayroll Deduction Agreement • October 23rd, 2018
Broome-Tioga BOCES Payroll Office PAYROLL DEDUCTION AGREEMENT CHEMUNG TRUST GHS PROCTOR + GAMBLE CU (PA) CITIZENS GUTHRIE FEDERAL CU SEFCU CITIZENS + NORTHERN BANK (PA) HSBC SERVU CU CORNING CREDIT UNION HORIZON SIDNEY FEDERAL CU DISCOVER BANK KEY BANK TD BANK ELMIRA SAVINGS BANK M&T BANK TIOGA STATE EMPOWER FEDERAL CU NBT USAA FEDERAL SAVINGS BANK FIRST HERITAGE FEDERAL CU NAVY FEDERAL CU UTILITIES CU FIRST LIBERTY BANK/COMMUNITY BAN PENN STAR (PA) VISIONS PEOPLES NATIONAL (PA) I hereby request that BOCES deposit such funds as I request to the above checked bank/credit union. You may choose up to two institutions. This agreement will become effective ten (10) business days after delivery to the Payroll Office of this authorization and may be terminated by me by written notification to the Payroll Office, in which case termination shall
EMPLOYER FAMILY PROTECTION PLAN PAYROLL DEDUCTION AGREEMENTPayroll Deduction Agreement • April 15th, 2014
COMPLETING IRS FORM 2159 PAYROLL DEDUCTION AGREEMENT FOR STATE OF NC EMPLOYEES/EMPLOYERS JOB AID PY-5Payroll Deduction Agreement • March 3rd, 2020
PROCESS TITLE: Procedure for Completing IRS Form 2159 – Payroll Deduction Agreement PROCESS OBJECTIVE: To provide instructions on completing IRS Form 2159 to initiate a payment
Please complete this form online, then print, sign and mail it to us.Payroll Deduction Agreement • December 28th, 2018
• Use this form to set up a payroll deduction plan and invest after-tax dollars directly from your paycheck to your Oakmark account.
PAYROLL DEDUCTION AGREEMENTPayroll Deduction Agreement • September 15th, 2020
Payroll Deduction AgreementPayroll Deduction Agreement • November 21st, 2006
PAYROLL DEDUCTION AGREEMENT Payroll Deduction Agreement • November 10th, 2020
I, the undersigned County (C) or Flood Control District (F) employee, hereby authorize the Harris County Auditor to make monthly payroll deductions from my pay in the following amount:
PAYROLL DEDUCTION AGREEMENT Randolph CollegePayroll Deduction Agreement • December 11th, 2012
This Agreement is legally binding and irrevocable for both the Institution and the Employee while employment continues. However, either party may terminate this Agreement as of the end of any month (or pay period, if applicable) by giving at least 30 days’ written notice. The Agreement will not apply to salary earned after the agreement is terminated.
ContractPayroll Deduction Agreement • October 31st, 2013
PAYROLL DEDUCTION AGREEMENT Payroll Deduction Agreement • October 1st, 2021
I, the undersigned County (C) or Flood Control District (F) employee, hereby authorize the Harris County Auditor to make biweekly payroll deductions (amount will not be deducted from the third pay period of the month).
PAYROLL DEDUCTION AGREEMENTPayroll Deduction Agreement • February 2nd, 2022
I, the undersigned County (C) or Flood Control District (F) employee, hereby authorize the Harris County Auditor to make biweekly payroll deductions (amount will not be deducted from the third pay period of the month).
ContractPayroll Deduction Agreement • April 5th, 2014
Form. No. CC001 Guarantor Name and Guarantor Number: GMHA Preparer’s Name, Date, and Signature: GOVERNMENT OF GUAM EMPLOYEE PAYROLL DEDUCTION AGREEMENT 1 TO: (Employer’s name and address) 2 Regarding: (Guarantor’s/Employee’s name and address) Social Security or Driver’s License Number: 2 EMPLOYER – Your employee, the Guarantor, identified above on the right named you as the responsible agency or party that oversees his or her payroll. Pursuant to 4 GCA §4307 and 5 GCA §20111, the Guarantor has elected payroll deduction as an option to satisfy his or her debt with GMHA. Although Guarantor and GMHA has negotiated to settle the Guarantor’s GMHA debt through payroll deduction, GMHA will not consider this agreement valid and binding, under the conditions and terms provided herein, until this form (CC001) has been completely filled out and signed by Guarantor and Employer. 3 TO BE COMPLETED BY EMPLOYER The Guarantor, , is employed with . The Guarantor is eligible for payroll deduction. T
PAYROLL DEDUCTION AGREEMENT FOR EMPLOYEE AND CHILD/CHILDREN CAFETERIA CHARGESPayroll Deduction Agreement • August 27th, 2013
The total amount deducted for Cafeteria charges will vary depending on the number of monthly charges made. Payroll deductions for Cafeteria charges are based on any charges made between the first of the month through the end of the same month (these deductions will be for the previous month) beginning with the September 27, 2013 payroll and will continue until all charges are paid for the 2013-2014 school year.
PAYROLL DEDUCTION AGREEMENT FORMPayroll Deduction Agreement • July 28th, 2020
This Agreement is made between you and Employer named above. This Agreement will change all payroll deduction contributions to the employee’s account(s). If an option in section A is left blank, it will be assumed that the election amount is zero. This agreement will remain in effect as long as your employment continues or until another agreement is exercised.
PAYROLL DEDUCTION AGREEMENT FOR VOLUNTARY EMPLOYEE PAID PROGRAMSPayroll Deduction Agreement • October 9th, 2018
