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Get Authorization for Voluntary Payroll Deduction

Ning the sum of $ (Amount) and ending (Date) until the total amount of $ (Date) has been deducted. (Amount) I am authorizing this voluntary deduction as specified in RSA 275:48 I. In the event my employment ends for any reason before the final deduction is made, the entire balance may (X) or may not (Employee’s Signature) (X) be deducted from my final wages. (Date signed) .

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