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Payroll Deduction Enrollment Form Name: Address: City, State, ZIP: Signature: Date: UNIT: Daytime Phone: Please apply my gift to: Staff Council Scholarships Tom Love ridge Scholarship Gift method:

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Step 1: Begin by writing your full name on the first line of the address form.

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Step 2: Write your street address, including the house number and street name, on the second line.

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Step 4: Write the city or town name on the fourth line.

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Step 5: Include the state name in full or its abbreviation on the fifth line.

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Step 6: Write the ZIP code on the last line of the address.

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