KENT STATE UNIVERSITY
AUTO LEASE SALARY DEDUCTION AUTHORIZATION
I authorize Kent State University to deduct from my monthly pay the personal use of my
leased University automobile, a
____________________________________ from ______________________________
(Year, Make, Model)
(Dealer)
____________________________________
(Serial Number)
Payroll deduction will begin with the pay of __________________________.
(Date)
Please deduct from each pay for ________ months using the following formula:
MONTHLY LEASE EXPENSE
PERSONAL RATE FOR LEASE
$__________
____x .25%
DEDUCTION PER PAY
$__________
NAME ____________________________ SOCIAL SECURITY NO. _______________
TITLE _________________________________________________________________
I have received a packet that explains how to properly document business and personal
mileage. I understand that I am responsible for timely submitting an automobile log on
a monthly basis. I acknowledge and agree that the university may charge additional
amounts for personal use and/or take additional tax from my paycheck if I do not
properly report my automobile usage.
SIGNATURE ____________________________________ DATE ____________
RETURN TO PAULA DIVENCENZO, 232 SCHWARTZ CENTER OR FAX TO 2-5434 FOR
PROCESSING.
PLEASE CALL PAULA DIVENCENZO AT EXTENSION 2-8622 IF YOU HAVE ANY
QUESTIONS.