"Payroll Stop Payment Reissue Request" - Delaware

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

Form Details:

  • Released on August 16, 2017;
  • The latest edition currently provided by the Delaware Office of the State Treasurer;
  • Ready to use and print;
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Download "Payroll Stop Payment Reissue Request" - Delaware

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STATE OF DELAWARE
  Office of the                                    
 
Payroll Stop Payment Reissue Request
State Treasurer                 
 
____________________________________________________________________________________________ 
*Please submit the detailed check register information from PHRST (Report DPR011)
 
Dept. #:  ____________________      Division:  ____________________      Section:  ____________________
 
 
 
ORIGINAL ISSUE
 
Check #:  
Date Issued:  
____________________          
____________________ 
 
 
RE‐ISSUE INFORMATION
 
Employee Name:  __________________________________________      Net Amount:  ___________________ 
Employee ID#:  _________________      Pay Period:  _________________      Gross Amount:  _______________  
Federal:  _______________________      State:  ________________________       Local:  __________________ 
OASDI:  ___________________      Medicare:  _________________      Misc. Deductions:  _________________ 
Reason for Reissue:  _________________________________________________________________________
 
 
MAILING or PICK‐UP
 
Mailing or Pick‐up Information:  ___________________________________________________ 
 
AGENCY CONTACT
 
Agency Contact:  _________________________________________________ 
Phone Number:   _________________________________________________
 
*Please submit the detailed check register information from PHRST (Report DPR011) 
 
 
Reset
Submit
 
____________________________________________________________________________________________ 
For the Office of the State Treasurer Use Only 
NEW ISSUE
 
New Check #:  
Date Issued:  
Net Amount:
___________________    
__________________     
  __________________ 
Payroll Stop Payment Reissue Request 
Page 1 of 1 
Created: 08/16/2017 
STATE OF DELAWARE
  Office of the                                    
 
Payroll Stop Payment Reissue Request
State Treasurer                 
 
____________________________________________________________________________________________ 
*Please submit the detailed check register information from PHRST (Report DPR011)
 
Dept. #:  ____________________      Division:  ____________________      Section:  ____________________
 
 
 
ORIGINAL ISSUE
 
Check #:  
Date Issued:  
____________________          
____________________ 
 
 
RE‐ISSUE INFORMATION
 
Employee Name:  __________________________________________      Net Amount:  ___________________ 
Employee ID#:  _________________      Pay Period:  _________________      Gross Amount:  _______________  
Federal:  _______________________      State:  ________________________       Local:  __________________ 
OASDI:  ___________________      Medicare:  _________________      Misc. Deductions:  _________________ 
Reason for Reissue:  _________________________________________________________________________
 
 
MAILING or PICK‐UP
 
Mailing or Pick‐up Information:  ___________________________________________________ 
 
AGENCY CONTACT
 
Agency Contact:  _________________________________________________ 
Phone Number:   _________________________________________________
 
*Please submit the detailed check register information from PHRST (Report DPR011) 
 
 
Reset
Submit
 
____________________________________________________________________________________________ 
For the Office of the State Treasurer Use Only 
NEW ISSUE
 
New Check #:  
Date Issued:  
Net Amount:
___________________    
__________________     
  __________________ 
Payroll Stop Payment Reissue Request 
Page 1 of 1 
Created: 08/16/2017