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Dept. Approver Name Date Department Title Phone Sign For HR Payroll Use Only Verification of Amount Due Approved By Next Pay Period Check Distributed Manual Check Pickup at 3 30 Mail To Payment Method Check Distributor s Signature Notes Time issued Date issued 1 of 1. Payroll Discrepancy Correction Form Submit form to Human Resources Office Employee will be reimbursed on the following payroll paycheck Employee Information Name Phone number Employee Status Active LOA Terminated Employee...
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