SARASOTA COUNTY EMERGENCY

SERVICES

Cancellation of Payroll Deduction

To:     Nikki Snyder, Payroll Manager

          Clerk of the Circuit Court

From: _______________________________________

Date:  _______________________________________

RE:    Cancellation of Payroll Deduction

I would like to request cancellation of the following deduction:

Deduction Type____________________________________________________

Deduction Amount ($) Bi-Weekly______________________________________

Payroll Date to be Stopped (within 30 days of this notice)______________________

______________________________            ______________________________

Employee’s Signature                                  Social Security #

  EmSBC 116                                                                                             Rev 02/06