TEXAS DEPARTMENT OF HOUSING AND COMMUNITY AFFAIRS
HOME Investment Partnerships Program
Payroll Deduction Authorization
Contract Administrator: Contractor or Subcontractor (employer): Employee Information and Authorization Name of Employee: Employee’s Home Address: Contract Number:
I (name of employee), hereby authorize deduction is for: Loan Repayment Charitable Donation Advance This deduction is to be made: One Time Only times for
(name of contractor/employer)to deduct $
from my paycheck. This
Retirement Insurance Premium Union Dues
Profit Sharing Savings Bonds Other:
Weekly weeks
Monthly Other:
Signature of Employee
Date
TDHCA - HOME Investment Partnerships Program Form 06.10 - Payroll Deduction Authorization
Page 1 of 1 January, 2006