AS-47 - Payroll Deduction .xlsx

	A	B	C	D	E	F	G	H	I	J	K
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2			AS-47
3			UNIVERSAL PAYROLL AUTHORIZATION					COMPANY ISP		PAYGROUP ISPSPU
4			State Form 44937 (R5/04-22)					COMPANY ISP		PAYGROUP ISPSPU
5			Approved by State Board of Accounts, 2022
6								BU 100	PEOPLE SOFT ID
7								BU 100
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9	LAST NAME				FIRST NAME Steven				MIDDLE NAME/INITIAL
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11	STREET ADDRESS							STATE			ZIP CODE
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14	START	CHANGE	STOP	DEDUCTION	$ AMOUNT	LIMIT		DEDUCTION DESCRIPTION
15	START	CHANGE	STOP	CODE	% PERCENT
16	X			POLALL	$ 16.00		POLALL - Police Alliance
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28	I hereby authorize my employer to deduct from my pay each payday for purpose(s) indicated on this form. This authorization shall remain in full force until termination of my employment or until cancelled by me in writing.
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30	SIGNATURE OF EMPLOYEE							DATE SIGNED (Month, Day, Year)
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