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Ohio Direct Deposit Form 1

Ohio Direct Deposit Form 1
AUTHORIZATION FOR DIRECT DEPOSIT OF PAY
State of Ohio
Dept. of Administrative Services
Employee Name
Social Security Number
Last
First
Middle Initial
I AUTHORIZE THE STATE OF OHIO TO DEPOSIT MY PAYROLL CHECK INTO MY ACCOUNT IN THE FINANCIAL INSTITUTION NAMED BELOW BY AUTOMATIC TRANSFER.
THIS AUTHORIZATION WILL REMAIN IN EFFECT UNTIL I SUBMIT A NEW FORM OR FORMS (SEE REVERSE SIDE).
NAME OF FINANCIAL INSTITUTION City State Transit Routing No.
SAVINGS ACCOUNT
OR
ACCOUNT
Employee Signature Date
Agency
Payroll
Number
USE FORM ADM-4286 TO
DISCONTINUE DIRECT DEPOSIT
ADM 4280 (REV. 4/2000)
CHECKING ACCOUNT
1
2
NUMBER
AUTHORIZATION FOR DIRECT DEPOSIT OF PAY
State of Ohio
Dept. of Administrative Services
Employee Name Social Security Number
Last First Middle Initial
I AUTHORIZE THE STATE OF OHIO TO DEPOSIT MY PAYROLL CHECK INTO MY ACCOUNT IN THE FINANCIAL INSTITUTION NAMED BELOW BY AUTOMATIC TRANSFER.
THIS AUTHORIZATION WILL REMAIN IN EFFECT UNTIL I SUBMIT A NEW FORM OR FORMS (SEE REVERSE SIDE).
NAME OF FINANCIAL INSTITUTION City State Transit Routing No.
SAVINGS ACCOUNT
OR
ACCOUNT
Employee Signature Date
Agency
Payroll
Number
USE FORM ADM-4286 TO
DISCONTINUE DIRECT DEPOSIT
ADM 4280 (REV. 4/2000)
CHECKING ACCOUNT
1
2
NUMBER
AUTHORIZATION FOR DIRECT DEPOSIT OF PAY
State of Ohio
Dept. of Administrative Services
Employee Name
Social Security Number
Last
First
Middle Initial
I AUTHORIZE THE STATE OF OHIO TO DEPOSIT MY PAYROLL CHECK INTO MY ACCOUNT IN THE FINANCIAL INSTITUTION NAMED BELOW BY AUTOMATIC TRANSFER.
THIS AUTHORIZATION WILL REMAIN IN EFFECT UNTIL I SUBMIT A NEW FORM OR FORMS (SEE REVERSE SIDE).
NAME OF FINANCIAL INSTITUTION City State Transit Routing No.
SAVINGS ACCOUNT
OR
ACCOUNT
Employee Signature Date
Agency
Payroll
Number
USE FORM ADM-4286 TO
DISCONTINUE DIRECT DEPOSIT
ADM 4280 (REV. 4/2000)
CHECKING ACCOUNT
1
2
NUMBER
Ohio Direct Deposit Form 1
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