Fillable Form 807: Authorization to Stop Payroll Deduction(s) (West Virginia Northern Community College)

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Form 807: Authorization to Stop Payroll Deduction(s) (West Virginia Northern Community College)

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Authorization to Stop Payroll Deduction(s)
Please complete all applicable information and return the signed form to the Human Resource Office,
Wheeling Campus, Room 102E, 1704 Market Street, Wheeling, WV 26003
I am authorizing WVNCC Payroll Office to stop the following payroll deduction(s):
_______________________________________________ __________________________
Signature Date
For Human Resource Office Use Only:
Payroll Date Deduction Stopped: Payroll Business Clerk Initials
Teachers REtirement Loan
Greatwest Supplemental (403)
American General LF & AGC
Steel Works Credit Union
State Credit Union
US Savings Bonds
Foundation-College Square Campus
Prepaid Legal Service
Greatwest Supplemental (457)
Capitol American Life Insurance
Other
TIAA Supplemental (403)
TIAA Supplemental (457)
Standard Group Disability
Foundation Contribution
American General Life Insurance
United Way Upper Ohio Valley
Employee Name: Last 4 digist of Social Security #:
DEDUCTION TYPE CODE EFFECTIVE DATE
807
370
770
675/676
685
699
686
329
702
328
377
339
770
825
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Form 807: Authorization to Stop Payroll Deduction(s) (West Virginia Northern Community College)

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Completed 27 July 2020

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