TEXAS A&M UNIVERSITY PRE-TAX PARKING DEDUCTION
CANCELLATION OR RE-ENROLLMENT
This form is to be used only for opting out of or re-enrolling in pre-tax parking deductions. You must be
enrolled in a university parking pass program as approved by Transportation Services. Any questions
about parking rates or processing deadlines should be directed to Transportation Services. Questions
about impact on benefits should be directed to TAMU Employee Services or your tax advisor/financial
Customers must submit this form between April 15 and July 15 each year to decline the pre-
tax benefit for the upcoming academic year.
1. PERSONAL INFORMATION
NAME UNIVERAL IDENTIFICATION NUMBER (UIN)
DEPARTMENT MAIL STOP
CAMPUS TELEPHONE CAMPUS EMAIL ADDRESS
The requested change will be requested in the next available billing cycle and may not be reflected on
your check for several pay cycles.
2. CANCELLATION/RE-ENROLLMENT (check appropriate box)
Cancel my pre-tax participation for the payment of my parking permit. I wish to pay all applicable
taxes on my current parking deduction.
I wish to have my parking deduction taken on a pre-tax basis.
SIGNATURE DATE TRANSPORTATION SERVICES APPROVAL DATE
SEND COMPLETED FORM TO TRANSPORTATION SERVICES:
By mail at 1250 TAMU
In person at 108 KOLDUS
By fax at 979.845.6025
FOR TRANSPORATION SERVICES USE ONLY
ENTRY DATE ENTERED BY
M:Customer Services/Forms/PRE TAX PAYROLL DEDUCTION FORM
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