St. Lucie TIGER PAC Payroll Deduction Form

Enter the employee information below. The preview updates as the form is completed.

The next screen shows the completed form for review before signature. You will have another opportunity to review the form after your signature before you submit the form.

Prefer to make a one-time contribution? Please use this link TIGER/COPE One Time Contribution instead of completing this payroll deduction form.

Employee name

Employee ID

Worksite / School

Job title / position

Home address

City / State / ZIP

Personal email

Phone

Payroll deduction election

$1 per pay period $2 per pay period $5 per pay period $10 per pay period Other per pay period

Other amount

One-time deduction amount

Effective date

Next available payroll period Specific date

Specific effective date

Printed name (verify)

Employee ID (verify)

Live preview

ST. LUCIE TIGER PAC

Payroll Deduction Authorization Form

Employer / Payroll Department: St. Lucie Public Schools | 9461 Brandywine Lane, Port St. Lucie, FL 34986-2209 | (772) 429-3600

EMPLOYEE INFORMATION

Employee Name

Employee ID

Worksite / School

Job Title / Position

Home Address

City / State / ZIP

Personal Email

Phone

PAYROLL DEDUCTION ELECTION

I authorize St. Lucie Public Schools to deduct the following voluntary contribution from my pay and remit it to St. Lucie TIGER PAC:

$1 per pay period

$2 per pay period

$5 per pay period

$10 per pay period

Other: $

per pay period

One-time deduction: $

Effective date:

Next available payroll period

Specific date:

VOLUNTARY CONTRIBUTION ACKNOWLEDGMENT

I understand that contributions to St. Lucie TIGER PAC are voluntary and will be used for political purposes. I am free to contribute more, less, or nothing at all without reprisal, and my decision will not affect my employment, compensation, union membership, representation, or any other right or benefit. PAC contributions are not tax deductible as charitable contributions. I affirm that this contribution is made from my own personal funds and will not be reimbursed by another person or entity.

AUTHORIZATION AND CANCELLATION

This authorization will remain in effect until I revoke it in writing, until I submit a new authorization, or until I am no longer employed by St. Lucie Public Schools. I may cancel or change this authorization by submitting written notice to St. Lucie TIGER PAC and/or the payroll office, subject to payroll processing deadlines.

Employee Signature:

Date:

Printed Name

Employee ID

FOR OFFICE USE ONLY

Received by:

Date received:

Payroll code: