HUMAN RESOURCES DEPARTMENT
______________________________________________________
PERMISSION TO RELEASE PAYROLL CHECK
Date: ________________________
I, ________________________________________, hereby grant permission to the Human
Print Name of Employee
Resources Department to release my payroll check to: _________________________________
Print Name of Person(s) Picking up Check(s)
_____________________________________________________________________________.
I understand this person must provide photo ID in order to pick up my payroll check.
_________________________________________
Employee’s Signature
Check One:
ONE BOX MUST BE MARKED
Permanent Basis (or until further notice)
Payroll of ________________________ only
MELANIE BAIRD-SIMMONS, HR MANAGER X5011
E-
MAIL mbaird-simmons@paysonaz.gov
K
ELLI SCHWEIN, HR ANALYST X5012
E-
MAIL kschwein@paysonaz.gov
K
ATHERINE JOST, PAYROLL SPECIALIST X5013
E-MAIL kjost@paysonaz.gov
TOWN OF
303 N BEELINE HWY
P
AYSON, AZ 85541
928
474-5242 FAX
928
474-1151
