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AUTHORIZATION FOR VOLUNTARY PAYROLL DEDUCTION I, hereby authorize the City of Whitefish, Montana to deduct from my wages, the sum of $ (check a box below): ☐for a one-time payment ☐per pay period (ongoing) ☐one-time per month (ongoing) (if available) ☐other (please explain) for ongoing deductions please indicate the: beginning and ending (date): for (please indicate reason for the deduction below): until the total amount of has been deducted. I am authorizing this as a voluntary deduction. In the event my employment ends for any reason before the final deduction is made, the entire unpaid balance will be deducted from my final wages. Should the final wages be insufficient to pay amounts due, unpaid balances will be immediately due to the City. (Employee’s Signature) (Date signed)