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AUTHORIZATION FOR PAYROLL DEDUCTION
______________________________ County Schools Date: ______________________________
I, __________________________________ (Full Name) do hereby officially authorize the chief fiscal officer or his/her designated representative, to perform the following deductions with respect to my salary for payment of professional dues.
Check the Proper Choices Below -------------Renewal or New
It is my understanding that the aggregate deduction, when possible, will be calculated for a reduction to my net salary via equal installments per pay period.
If I terminate my employment during the school term, I ________________________________ do hereby authorize said fiscal officer to perform all respective deductions as denoted herein, in full, within my final paycheck.
In executing this request, I do hereby recognize that it is completely binding and cannot be altered, in any manner, during the fiscal year applicable thereto.
Note to County Office: Please send all payment checks to: