Fillable Dd Form 2761 - Personal Check Cashing Agreement (Page 2 of 2) in pdf

Dd Form 2761 - Personal Check Cashing Agreement Page 2

Download a blank fillable Dd Form 2761 - Personal Check Cashing Agreement in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Dd Form 2761 - Personal Check Cashing Agreement with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

NOTE: If individual has been transferred, forward this

PAY ADJUSTMENT AUTHORIZATION

authorization to the officer currently maintaining

the individual's pay record.

1. MEMBER/EMPLOYEE NAME (Last, First, Middle)

2. SSN

3. RANK/GRADE

4. BRANCH OF SERVICE

5. PAY GRADE NUMBER

6. AMOUNT

7. APPROPRIATION DATA

8. FROM

9. NAME OF ACCOUNTABLE DISBURSING OFFICER

(D.O.)

10. D.O. SYMBOL

11. G.A.O. EXCEPTION

CODE

12. TO

13. YOU ARE HEREBY AUTHORIZED TO DEDUCT

THE AMOUNT OF

_______________________

FROM THE ACCOUNT OF THE ABOVE NAMED

INDIVIDUAL.

14. EXPLANATION AND/OR REASON FOR ADJUSTMENT

I CERTIFY that this collection is the result of dishonored personal checks cashed by the cited individual for the amounts

stated. The individual has consented in writing, that in consideration for cashing the individual's check(s) the amount of any

check returned unpaid for any reason, plus any charges assessed against the government by a financial institution, may be

collected from the individual's pay.

15. FROM

16. DISBURSING OFFICER

a. NAME (Last, First, Middle Initial)

b. RANK/GRADE c. SIGNATURE

I CERTIFY that the adjustment indicated above has been entered on the above-named individual's Pay Record.

(If adjustment has not been entered, give explanation in the space provided above.)

17. TO

18. PAYROLL OFFICER

a. NAME (Last, First, Middle Initial) (Type or Print)

b. RANK/GRADE

19. PAYROLL DSSN

20. DATE

21. SIGNATURE

DD FORM 2761 (BACK), APR 2007

Reset

Dd Form 2761 - Personal Check Cashing Agreement Page 2

Related Articles

Related forms

Related Categories