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Signature 3. Have you ever been a member of the California State Teachers Retirement System CalSTRS YES For Payroll Use Only Salary agreement Blue Cross/ Kaiser Dependents W-4 EDD STRS or 401a POP FSA NO HR - Payroll Form W-4 2017 Purpose. This agreement will remain in effect until LPS receives a written notice of cancellation from me or my Account Information Employee Name Name of Financial Institution Routing Number Checking Savings Account Number Authorized Signature Primary Request for...

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