NEW JERSEY INSTITUTE OF TECHNOLOGY
STOP PAYMENT MEMORANDUM
DATE: _______________
THE MEMORANDUM ATTESTS TO THE FACT THAT I DID NOT RECEIVE THE FOLLOWING
PAYROLL CHECK.
NAME____________________________________________________________
SS #/NJIT ID #______________________________________________________________
DATE OF CHECK_______________ CHECK #________________ AMOUNT_______________
THE CHECK WAS: (CIRCLE ONE)
1. Picked up by my department but not given to me.
2. Mailed by my department.
3. Mailed by the Payroll Department.
4. I lost/misplaced the check.
5. Check has passed the expired issued date.
6. Email/letter sent by Payroll Department for expired check.
7. Direct deposit reversal.
I understand that the Payroll Department will place a STOP PAYMENT on the check and I must return in
person to the Payroll Department to obtain a replacement. I also understand that if I receive the original check in
the mail that I will not cash it, but notify Payroll as soon as possible.
And I also understand that I
have two weeks to return to the Payroll Office for a replacement check.
_______________________________ _____________________________________
Signature Phone Number
______________________________________
E-Mail Address
In the event that my missing check was endorsed and cashed, and the endorsement turns out to be forgery, my
signature is as above, and I will return to Payroll Department to fill out an
AFFIDAVIT OF FORGERY-
MAKER OF ENDORSER Form to be filed with Wells Fargo Bank.
___________________________________________________________________________________________
FOR OFFICE USE:
DATE OF STOP PAYMENT________________ STOP PLACE BY________________
DATE CHECK WAS CASHED_________________ REISSUED DATE__________________
COMMENTS:
