If You Have Requested to Receive a Lump Sum Payment.
Please Read The Following carefully...
1. I acknowledge that I am responsible for making any desired changes to my federal and state income tax exemptions in Business Plus Employee Online system begining 5/31/2021 to 06/04/2021. I understand that changes I make will remain in place until I change them again. I understand that the Business Office cannot give tax advice, and I should consult with a tax professional if I have any questions regarding taxes or exemptions.
The W-4 Federal withholding form does not allow exemptions, please follow the instructions that are attached to the W4.
2. I acknowledge that the following deductions, if applicable, will be deducted at 4 times the standard rate to reflect the 4 pay periods in June and July: Health insurance, dental insurance, vision insurance, optional group life insurance, short-term disability insurance, al critical care insurance, flex spending, health savings accounts, 403 (b) Roth, and 457 (b) Tax Sheltered Annuities.
3. I acknowledge that United Way contributions will be deducted at 2 times the standard rate to reflect the month of June only.
4. I acknowledge that all garnishments or wage attachments, if applicable, must be deducted at the rate required by the court order. In most cases, this will be 4 times the standard rate.
5. I acknowledge that if my pay is being docked, or I have entered into a payment arrangement with the district for any reason, the deduction will be calculated based on the existing agreement with the Human Resources Department. In most cases, this will be 4 times the standard rate.
By signing below, I understand USD500 will make deductions from my June 15, 2021 check in Accordance with the terms indicated above.
The deadline for completing and submitting the form is Friday, April 30,2021
You may also request a fillable PDF version of this form that can be completed, signed and faxed to (913) 551-3264 or email email@example.com or firstname.lastname@example.org.