Sample Authorization for Voluntary Payroll Deduction Form - Free Download
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FOR VOLUNTARY PAYROLL DEDUCTION
Allowed under RSA 275:48 I
(Print employee’s name)
to deduct from my wages
(reason for the deduction)
the sum of $
until the total amount of $
has been deducted.
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.