2022-2023

PARKING DECAL

PAYROLL DEDUCTION AUTHORIZATION

I hereby authorize Louisiana Tech University to withhold $100.00 from my payroll check
according to the schedule below or until the $100.00 has been paid in full.

I am a Full-time Permanent Employee (check one below):

_____ Bi-Weekly

_____ Monthly

Payroll Deduction Schedule

Bi-Weekly Payroll Check Monthly Payroll Check
September 16, 2022 $12.50 September 30, 2022 $25.00
September 30, 2022 $12.50 October 31, 2022 $25.00
October 14, 2022 $12.50 November 30, 2022 $25.00
October 28, 2022 $12.50 December 29, 2022 $25.00
November 10, 2022 $12.50
November 23, 2022 $12.50
December 9, 2022 $12.50
December 22, 2022 $12.50

________________________________
Faculty/Staff Signature

________________________________
Faculty/Staff Printed Name

________________________________
Campus Wide ID #

________________________________
Date

Please return the completed Vehicle Authorization and Parking Decal Payroll Deduction
Authorization Forms to Louisiana Tech University Police.