REVOCATION OF PAYROLL DEDUCTION

(Not for SIUE Credit Union deduction; please contact the Credit Union directly to revoke a deduction.)
Please discontinue the following deduction which is now being made from my paycheck.
EFFECTIVE NEXT AVAILABLE PAYROLL	Amount deducted per pay:
Deduction for:
(organization)
Employee Name:	Banner ID:

Street:

City:	State:	Zip:
SIGNATURE:
DATE:
Office Use Only:	EFFECTIVE:
5/7/12 – previous versions obsolete

Please submit two originals to the Office of Human Resources, Box 1040.

One original must be on file in HR, and the other original must be sent to the applicable organization.

REVOCATION OF PAYROLL DEDUCTION

(Not for SIUE Credit Union deduction; please contact the Credit Union directly to revoke a deduction.)
Please discontinue the following deduction which is now being made from my paycheck.
EFFECTIVE NEXT AVAILABLE PAYROLL	Amount deducted per pay:
Deduction for:
(organization)
Employee Name:	Banner ID:

Street:

City:	State:	Zip:
SIGNATURE:
DATE:
Office Use Only:	EFFECTIVE:

5/7/12 – previous versions obsolete

REVOCATION OF PAYROLL DEDUCTION

OIT

2012-05-14

Joyree Chura

SIUE