UNIVERSITY OF NORTHERN IOWA
AUTHORIZATION FOR PAYROLL DEDUCTION
TO: University of Northern Iowa
I hereby request and authorize you to deduct from my earnings an amount sufficient to provide for the regular payment of the current rate of monthly withholding established by United Faculty. The amount shall be certified by the organization noted and any change in such amount shall be so certified. The amount deducted shall be paid to the organization shown with this form. This authorization shall remain in full force and effect unless terminated by me with written notice to my employer, as provided by law.
Cancellation of Authorization to Withhold Wages
Please be advised that I wish to cancel the above authorization to withhold wages
effective with the ____________________________ (month and year) payroll (as provided by law).
Signature of staff member Date, month and year termination agreement