Sample Authorization for Voluntary Payroll Deduction Form - Free Download
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Sample Authorization for Voluntary Payroll Deduction Form
Sample Authorization for Voluntary Payroll Deduction Form
AUTHORIZATION
FOR VOLUNTARY PAYROLL DEDUCTION
Allowed under RSA 275:48 I
I,
hereby authorize
(Print employee’s name)
to deduct from my wages
(Employer)
for:
(reason for the deduction)
the sum of $
, beginning
and ending
(Amount)
(Date) (Date)
until the total amount of $
has been deducted.
(Amount)
I am authorizing this voluntary deduction as specified in RSA 275:48 I.
In the event my employment ends for any reason before the final deduction is made, the
entire balance may
(X) or may not
(X) be deducted from my final wages.
(Employee’s Signature)
(Date signed)
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