Form ADM6307 "Authorization for Payroll Deduction" - Ohio

What Is Form ADM6307?

This is a legal form that was released by the Ohio Department of Administrative Services - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2007;
  • The latest edition provided by the Ohio Department of Administrative Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form ADM6307 by clicking the link below or browse more documents and templates provided by the Ohio Department of Administrative Services.

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Download Form ADM6307 "Authorization for Payroll Deduction" - Ohio

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State of Ohio
AUTHORIZATION FOR PAYROLL DEDUCTION
Department of Administrative Services
ADM 6307 Rev. 11-07
Employee Name________________________________________
Employee ID Number_____________
Last
First
Middle
I hereby authorize the State of Ohio to make the following Deduction from my earnings:
New Authorization
Change
Cancellation
Do Not Wish to Enroll
Medical Insurance (Complete Health Care Form)
Single
Family
Insurance
Charity Pledge
Union Deduction (No Need to Fill in Amount Below)
PAYROLL OFFICER
Credit Union (Complete Credit Union Membership Form)
City Income Tax
PAYROLL NUMBER _______________________
Savings Bond (Complete US Savings Bond Card)
Other ___________________________________________________________
WORK LOCATION ________________________
DEDUCT: % or Amount ___________
Effective Date ___________
DATE __________________________________
Deduction
PAYABLE TO: __________________________________
Code _____________
SIGNATURE_____________________________
Employee Signature __________________________________________________
State of Ohio
AUTHORIZATION FOR PAYROLL DEDUCTION
Department of Administrative Services
ADM 6307 Rev. 11-07
Employee Name________________________________________
Employee ID Number_____________
Last
First
Middle
I hereby authorize the State of Ohio to make the following Deduction from my earnings:
New Authorization
Change
Cancellation
Do Not Wish to Enroll
Medical Insurance (Complete Health Care Form)
Single
Family
Insurance
Charity Pledge
Union Deduction (No Need to Fill in Amount Below)
PAYROLL OFFICER
Credit Union (Complete Credit Union Membership Form)
City Income Tax
PAYROLL NUMBER _______________________
Savings Bond (Complete US Savings Bond Card)
Other ___________________________________________________________
WORK LOCATION ________________________
DEDUCT: % or Amount ___________
Effective Date ___________
DATE __________________________________
Deduction
PAYABLE TO: __________________________________
Code _____________
SIGNATURE_____________________________
Employee Signature __________________________________________________
State of Ohio
AUTHORIZATION FOR PAYROLL DEDUCTION
Department of Administrative Services
ADM 6307 Rev. 11-07
Employee Name________________________________________
Employee ID Number_____________
Last
First
Middle
I hereby authorize the State of Ohio to make the following Deduction from my earnings:
New Authorization
Change
Cancellation
Do Not Wish to Enroll
Medical Insurance (Complete Health Care Form)
Single
Family
Insurance
Charity Pledge
Union Deduction (No Need to Fill in Amount Below)
PAYROLL OFFICER
Credit Union (Complete Credit Union Membership Form)
City Income Tax
PAYROLL NUMBER _______________________
Savings Bond (Complete US Savings Bond Card)
Other ___________________________________________________________
WORK LOCATION ________________________
DEDUCT: % or Amount ___________
Effective Date ___________
DATE __________________________________
Deduction
PAYABLE TO: __________________________________
Code _____________
SIGNATURE_____________________________
Employee Signature __________________________________________________
State of Ohio
AUTHORIZATION FOR PAYROLL DEDUCTION
Department of Administrative Services
ADM 6307 Rev. 11-07
Employee Name________________________________________
Employee ID Number_____________
Last
First
Middle
I hereby authorize the State of Ohio to make the following Deduction from my earnings:
New Authorization
Change
Cancellation
Do Not Wish to Enroll
Medical Insurance (Complete Health Care Form)
Single
Family
Insurance
Charity Pledge
Union Deduction (No Need to Fill in Amount Below)
PAYROLL OFFICER
Credit Union (Complete Credit Union Membership Form)
City Income Tax
PAYROLL NUMBER _______________________
Savings Bond (Complete US Savings Bond Card)
Other ___________________________________________________________
WORK LOCATION ________________________
DEDUCT: % or Amount ___________
Effective Date ___________
DATE __________________________________
Deduction
PAYABLE TO: __________________________________
Code _____________
SIGNATURE_____________________________
Employee Signature __________________________________________________
State of Ohio
AUTHORIZATION FOR PAYROLL DEDUCTION
Department of Administrative Services
ADM 6307 Rev. 11-07
Employee Name________________________________________
Employee ID Number_____________
Last
First
Middle
I hereby authorize the State of Ohio to make the following Deduction from my earnings:
New Authorization
Change
Cancellation
Do Not Wish to Enroll
Medical Insurance (Complete Health Care Form)
Single
Family
Insurance
Charity Pledge
Union Deduction (No Need to Fill in Amount Below)
PAYROLL OFFICER
Credit Union (Complete Credit Union Membership Form)
City Income Tax
PAYROLL NUMBER _______________________
Savings Bond (Complete US Savings Bond Card)
Other ___________________________________________________________
WORK LOCATION ________________________
DEDUCT: % or Amount ___________
Effective Date ___________
DATE __________________________________
Deduction
PAYABLE TO: __________________________________
Code _____________
SIGNATURE_____________________________
Employee Signature __________________________________________________
State of Ohio
AUTHORIZATION FOR PAYROLL DEDUCTION
Department of Administrative Services
ADM 6307 Rev. 11-07
Employee Name________________________________________
Employee ID Number_____________
Last
First
Middle
I hereby authorize the State of Ohio to make the following Deduction from my earnings:
New Authorization
Change
Cancellation
Do Not Wish to Enroll
Medical Insurance (Complete Health Care Form)
Single
Family
Insurance
Charity Pledge
Union Deduction (No Need to Fill in Amount Below)
PAYROLL OFFICER
Credit Union (Complete Credit Union Membership Form)
City Income Tax
PAYROLL NUMBER _______________________
Savings Bond (Complete US Savings Bond Card)
Other ___________________________________________________________
WORK LOCATION ________________________
DEDUCT: % or Amount ___________
Effective Date ___________
DATE __________________________________
Deduction
PAYABLE TO: __________________________________
Code _____________
SIGNATURE_____________________________
Employee Signature __________________________________________________
EMPLOYEE INSTRUCTIONS
PAYROLL OFFICER INSTRUCTIONS
1.
Return this card to your payroll officer
1.
Insert the deduction amount and deduction code on the
payroll journal.
2.
Health Insurance, Dental Insurance, and US Savings
Bonds require additional enrollment forms which you
2.
Send Health and Dental enrollment cards to Benefits
must also return to your payroll officer.
Administration.
3.
Employees in union positions (non-exempt) will have a
3.
Send US Savings Bond enrollment cards to Payroll
service fee automatically deducted from their pay
Deductions.
check and sent to the union. If you wish to join the
union, check the union membership block on this card.
4.
For all other deductions, indicate the name of the
provider who should receive your donation.
EMPLOYEE INSTRUCTIONS
PAYROLL OFFICER INSTRUCTIONS
1.
Return this card to your payroll officer
1.
Insert the deduction amount and deduction code on the
payroll journal.
2.
Health Insurance, Dental Insurance, and US Savings
Bonds require additional enrollment forms which you
2.
Send Health and Dental enrollment cards to Benefits
must also return to your payroll officer.
Administration.
3.
Employees in union positions (non-exempt) will have a
3.
Send US Savings Bond enrollment cards to Payroll
service fee automatically deducted from their pay
Deductions.
check and sent to the union. If you wish to join the
union, check the union membership block on this card.
4.
For all other deductions, indicate the name of the
provider who should receive your donation.
EMPLOYEE INSTRUCTIONS
PAYROLL OFFICER INSTRUCTIONS
1.
Return this card to your payroll officer
1.
Insert the deduction amount and deduction code on the
payroll journal.
2.
Health Insurance, Dental Insurance, and US Savings
Bonds require additional enrollment forms which you
2.
Send Health and Dental enrollment cards to Benefits
must also return to your payroll officer.
Administration.
3.
Employees in union positions (non-exempt) will have a
3.
Send US Savings Bond enrollment cards to Payroll
service fee automatically deducted from their pay
Deductions.
check and sent to the union. If you wish to join the
union, check the union membership block on this card.
4.
For all other deductions, indicate the name of the
provider who should receive your donation.
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