Fillable PAYROLL DEDUCTION AUTHORIZATION FORM MESCALERO APACHE TRIBAL COURT (Mescalero Apache Tribe)

Fill Online, Printable, Fillable, Blank PAYROLL DEDUCTION AUTHORIZATION FORM MESCALERO APACHE TRIBAL COURT (Mescalero Apache Tribe) Form

Use Fill to complete blank online MESCALERO APACHE TRIBE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

PAYROLL DEDUCTION AUTHORIZATION FORM MESCALERO APACHE TRIBAL COURT (Mescalero Apache Tribe)

On average this form takes 8 minutes to complete

The PAYROLL DEDUCTION AUTHORIZATION FORM MESCALERO APACHE TRIBAL COURT (Mescalero Apache Tribe) form is 2 pages long and contains:

  • 0 signatures
  • 15 check-boxes
  • 23 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Mescalero Apache Tribe forms online.

BROWSE MESCALERO APACHE TRIBE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Mescalero Tribal Court (2018) PO Box 227 / 159 Deer Trail Mescalero, NM 88340
PAYROLL DEDUCTION AUTHORIZATION FORM
MESCALERO APACHE TRIBAL COURT
Complete this form to initiate a payroll deduction to be submitted to your payroll office. A separate form must
be completed for each transaction.
Employee Name: __________________________________ Employee ID No.: ______________________
Department/Agency: _______________________________ Work Phone: __________________________
Payroll Dept. Contact Name: _______________________________ Phone No.:______________________
Check the appropriate box: ☐ Initiate payroll deduction ☐ Change payroll deduction
☐ Terminate payroll deduction.
ORDER. You, the Employer, are hereby ORDERED to deduct from the above named employee’s payroll the
amount listed below. You are ordered to begin deductions, on the first pay day after you receive this Order. If
the first pay day is within 10 days after you receive this Order, you may begin deductions on the second pay day
after you receive this Order. You are ordered to continue deductions until you receive notification to suspend or
discontinue deductions. You are further ORDERED to forward to the Mescalero Apache Tribal Court all wage
garnishments deducted by you under this order within three (3) business days of the withholding.
Check payable to: _______________________ Cause No: ____________________
_______________________
_______________________
Payment mailing address: Mescalero Apache Tribal Court Overnight/Physical Address
PO Box 227 159 Deer Trail
Mescalero, NM 88340 Mescalero, NM 88340
Monthly Payroll Total Amt. due: $__________ Bi-weekly Payroll Total Amt. due: $___________
Amount to be deducted each month: $__________ Amount to be deducted each pay period: $_________
Final payment: $_______________ Final payment: $_______________
Starting Date: _________________ (mm/yy) Starting Date: _________________ (mm/dd/yy)
Number of Installments: Number of Installments:
☐ 12 (1 year) ☐ 24 (2 years) ☐ 36 (3 years) ☐ 26 (1 year) ☐ 52 (2 years) ☐ 78 (3 years)
☐ 1 Full Payment ☐ Other: ________________ ☐ 1 Full Payment ☐ Other: ____________________
☐ Court Order issued by Mescalero Apache Tribal Court is attached. Employee signature not required.
☐ This is the ORDER of the Mescalero Apache Tribal Court as issued by the Judge’s signature below.
☐ Voluntary payroll deduction request is attached.
(SEAL) __________________________________
Mescalero Apache Tribal Court
Dated this ______ day of _________________, 20____
Mescalero Tribal Court (2018) PO Box 227 / 159 Deer Trail Mescalero, NM 88340
PAYROLL DEDUCTION AUTHORIZATION FORM
MESCALERO APACHE TRIBAL COURT
☐ Voluntary Payroll deduction request. ☐ Voluntary Dividend deduction request.
1. I hereby authorize the Mescalero Apache Tribal Court to initiate a payroll deduction,
terminate a payroll deduction, or change a payroll deduction, as appropriate. If this is a
Voluntary Dividend deduction request, I hereby authorize the Mescalero Apache Tribal
Court to forward and initiate to the Mescalero Apache Tribe.
2. I understand that if I am initiating or changing a payroll deduction, the deduction may not
be made if I have insufficient income in a pay period to cover this and all other required
(e.g. taxes) and authorized deductions, and will not hold the Mescalero Apache Tribal Court
liable for any deductions not made.
3. I understand, if a termination is made in payroll deduction, the deduction may still be taken
during the current payroll cycle due to the time needed to process the termination, and will
not hold the Mescalero Apache Tribal Court liable for any deductions made. It will be my
responsibility to collect from the organization any overpayment that may result.
4. I understand, if a change is made in payroll deduction, the change may not take effect
during the current payroll cycle due to the time needed to process the change, and will not
hold the Mescalero Apache Tribal Court liable for any deductions. It will be my
responsibility to collect from the organization any overpayment or pay the organization any
short payment that may result.
5. I understand, if I am requesting a Voluntary Dividend deduction request that #3 and #4
listed above may also apply to my Dividend.
________________________________ _________________________
Employee Signature Date
(SEAL) __________________________________
Mescalero Apache Tribal Court
Dated this ______ day of _________________, 20____.
Mescalero Tribal Court (2018) PO Box 227 / 159 Deer Trail Mescalero, NM 88340
PAYROLL DEDUCTION AUTHORIZATION FORM
EMPLOYER CERTIFICATION
NOTICE TO EMPLOYERS: The Employer must complete and return this certification to the Mescalero
Apache Tribal Court within 20 days of receipt.
To be completed by Mescalero Apache Tribal Court:
Date of Order: _____________________________ Date to Employer: ____________________________
Employee Name: ______________________________
Employee Social Security No.: __________________ Employee ID No.: ____________________________
Cause No: ___________________________________
The remainder of the Employer Certification is to be completed by Employer:
Employer: _____________________________________ Phone No: ____________________________
Contact Name: __________________________________ Email: ________________________________
1. The Employer received the Payroll Deduction Order concerning the above named employee on:
_____________________ (date)
2. Check one of the following:
a. _______ The above named Employee is currently employed with this Employer, or
b. _______ The above named Employee is no longer employed by this Employer.
Please provide the following information for the employees no longer employed:
Employment termination date: ______________________ Employee current employer (if known):
Employee’s last known address and phone no. (
if known): _____________________________________
_____________________________________________ _____________________________________
_____________________________________________ _____________________________________
_________________________________________ _____________________________________
Signature of Employer Representative Date
_________________________________________ _____________________________________
Printed Name Title
_________________________________________ _____________________________________
Direct Phone Number Email Address
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

PAYROLL DEDUCTION AUTHORIZATION FORM MESCALERO APACHE TRIBAL COURT (Mescalero Apache Tribe)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 31 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document