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Cortland County AUTHORIZATION FOR DIRECT DEPOSITS I, hereby authorize Cortland County, to initiate direct deposits and to initiate, if necessary, debit and adjustments for any direct deposit in error to my checking savings account indicated below and the bank named below BANK Routing AMOUNT TO BE DEPOSITED:___________OR ENTIRE CHECK(NET) TO BE DEPOSITED SECOND ACCOUNT INFORMATION: checking savings BANK Routing AMOUNT TO BE DEPOSITED:___________OR ENTIRE CHECK(NET) TO BE DEPOSITED This authority is to remain in full force and effect until Cortland County has received written notification from me of its termination in such time and in such manner as to afford Cortland County at least one payroll period to act on it. NAME DATE SIGNATURE Please provide a voided check or Statement from your bank to verify information submitted above.