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AUTHORIZATION TO MAIL PAYCHECK
I, ____________________________, voluntarily authorize the City of Iowa City (print or type name)
to forward my paycheck by U.S. mail. I understand that without such written authorization, the City
will no longer be able to forward my paycheck by mail. I further understand that this authorization
may be revoked at any time, and for any stated time period, with written notice to the City’s Human
Resources Division.
□ Please mail my bi-weekly paychecks.
□ If a week or more has passed and I have not picked up my paycheck, I authorize the
City of Iowa City to mail my check to the last mailing address shown on the City’s
payroll records.
□ Please mail my termination check.
(signature) (date)
(department)
Return authorization form to Human Resources, City of Iowa City, 410 E. Washington St., Iowa
City, IA 52240.
Humanrel/mailcheck.doc