LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER – Shreveport
Payroll Division
Request For Duplicate Check Stub
MAIL TO: LSUHSC-SHREVEPORT 1501 KINGS HIGHWAY P O BOX 33932 SHREVEPORT, LA 71130-3932 PAYROLL DEPARTMENT (318) 675-5214 REQUEST FOR CHECK STUBS PLEASE PRINT Please reissue a duplicate check stub for the following employee, for the pay period ending: ___________________ ___________________ ___________________ ___________________ Employee Name: _______________________________ Extension: __________ Social Security Number: _______ - _______ - _______ Employee ID #: _____________ EMPLOYEE CURRENT MAILING ADDRESS: Street Address: _____________________________________________ City: ________________________ State: ________ Zip Code: _________
Reset Form
ATTN: FAX#:
_________________________ Employee Signature
___________________ Date
NOTE : PLEASE ALLOW 24-48 HOURS FOR DUPLICATE REQUEST TO BE PROCESSED.