"Payroll Deduction Authorization Form - Post-tax Benefits Only" - Florida

Payroll Deduction Authorization Form - Post-tax Benefits Only is a legal document that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida.

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PAYROLL DEDUCTION AUTHORIZATION
 
POST‐TAX BENEFITS ONLY 
DEPARTMENT OF JUVENILE JUSTICE 
 
 
 
 
START DEDUCTION   
Please start my payroll deduction under code _____________, for $ _____________. ______effective 
with my pay warrant date _______/________/_________.    
 
 CHANGE DEDUCTION   
Please change my payroll deduction under code _____________, for $ _____________. ______effective 
with my pay warrant date _______/________/_________.    
 
CANCEL DEDUCTION:  
Please stop my payroll deduction under code _______________, for $ _____________. ______effective 
with my pay warrant date _______/________/_________.    
 
__________________________________  
  ______________________________  
Employee Name (Print)  
  
  
 Employee Signature  
  
_________________________________  
______________________________ 
People First ID #  
 
 
 
Date 
  
ATTN:  Emily Reker, Post Tax Benefits Coordinator 
 
Florida Department of Juvenile Justice 
 
Bureau of Human Resources 
 
2737 Centerview Drive 
 
Knight Building 
 
Tallahassee, FL 32399‐3100 
 
 
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PAYROLL DEDUCTION AUTHORIZATION
 
POST‐TAX BENEFITS ONLY 
DEPARTMENT OF JUVENILE JUSTICE 
 
 
 
 
START DEDUCTION   
Please start my payroll deduction under code _____________, for $ _____________. ______effective 
with my pay warrant date _______/________/_________.    
 
 CHANGE DEDUCTION   
Please change my payroll deduction under code _____________, for $ _____________. ______effective 
with my pay warrant date _______/________/_________.    
 
CANCEL DEDUCTION:  
Please stop my payroll deduction under code _______________, for $ _____________. ______effective 
with my pay warrant date _______/________/_________.    
 
__________________________________  
  ______________________________  
Employee Name (Print)  
  
  
 Employee Signature  
  
_________________________________  
______________________________ 
People First ID #  
 
 
 
Date 
  
ATTN:  Emily Reker, Post Tax Benefits Coordinator 
 
Florida Department of Juvenile Justice 
 
Bureau of Human Resources 
 
2737 Centerview Drive 
 
Knight Building 
 
Tallahassee, FL 32399‐3100 
 
 
SAVE AS
RESET/CLEAR
PRINT
E-MAIL