"Payroll Stop Payment Reissue Request Form" - Delaware

Payroll Stop Payment Reissue Request Form is a legal document that was released by the Delaware Office of the State Treasurer - a government authority operating within Delaware.

Form Details:

  • The latest edition currently provided by the Delaware Office of the State Treasurer;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Delaware Office of the State Treasurer.

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Download "Payroll Stop Payment Reissue Request Form" - Delaware

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PAYROLL STOP PAYMENT REISSUE REQUEST
Dept. #: _______________
Division: ____________
Section: _______________
VOIDED ISSUE
Check #: ___________
Date Issued: ________
RE-ISSUE INFORMATION
Employee Name: ___________________________________________________________________________
Net Amount: _______________________________
Employee ID#: ________________________________
Pay Period: _________________________________
Gross Amount: _______________________________
Federal: ____________________________________
State: _______________________________________
Local: ______________________________________
OASDI: ______________________________________
Medicare: ___________________________________
Other: ______________________________________
Reason for Reissue: ___________________________________________________________________________
Mailing or Pick-up Information: ________________________________________________________________
*Please submit the detailed check register information from PHRST (Report DPR011)
NEW ISSUE
For The Office of the State Treasurer Use Only
New Check #: ______________
Date Issued: _____________
Net Amount: ___________________
PAYROLL STOP PAYMENT REISSUE REQUEST
Dept. #: _______________
Division: ____________
Section: _______________
VOIDED ISSUE
Check #: ___________
Date Issued: ________
RE-ISSUE INFORMATION
Employee Name: ___________________________________________________________________________
Net Amount: _______________________________
Employee ID#: ________________________________
Pay Period: _________________________________
Gross Amount: _______________________________
Federal: ____________________________________
State: _______________________________________
Local: ______________________________________
OASDI: ______________________________________
Medicare: ___________________________________
Other: ______________________________________
Reason for Reissue: ___________________________________________________________________________
Mailing or Pick-up Information: ________________________________________________________________
*Please submit the detailed check register information from PHRST (Report DPR011)
NEW ISSUE
For The Office of the State Treasurer Use Only
New Check #: ______________
Date Issued: _____________
Net Amount: ___________________