Stop Payroll Deduction Permit Form

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S
P
D
P
F
TOP
AYROLL
EDUCTION
ERMIT
ORM
IMPORTANT: In order to elect the option to stop payroll deduction for your parking permit, please complete
this form, print it out, and bring it IN PERSON to the Transportation Services office.
Name: ________________________________________________________________________________________________________________
EMPLID: __________________________________________
Permit #: __________________________________________
Address: _____________________________________________________________________________________________________________
I hereby request the payroll deduction for my Continuous Parking Permit be discontinued by Transportation
Services. In doing this, I agree to return my permit and any accessories (e.g. gate card, clicker, etc.) to the
Transportation Services office upon the submission of this form.
_________________________________________________________________________
__________________
Signature of Employee
Date
O
U
O
FFICE
SE
NLY
_________________________________________________________________________
__________________
Entered into system by
Date
850.644.5278 / transportation.fsu.edu • UCC5406, Tallahassee, FL 32306 M-F, 7:30AM-5:00PM

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