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COUNTY OF HAWAII HILO, HAWAII ASSIGNMENT OF SALARY FOR COUNTY EMPLOYEE'S PARKING STALL FEE For value received, the undersigned hereby assigns to the DIRECTOR OF FINANCE, COUNTY OF HAWAII, the sum of$ from the payroll applicable for the month(s) of ; and thereafter, the sum of$ from the end of month payroll, each month beginning to pay for each following month's parking stall fee to the County of Hawaii, and hereby authorizes the Director of Finance to deduct said amounts from such salary or wages due. Furthermore, I hereby authorize the Director of Finance to deduct the appropriate monthly fee applicable for this stall or any other stall in the same class due to any approved future rate increases until this salary assignment is revoked by the County or myself. Employee's Signature Employee's Name Employee # Department ❑County Building ❑Aupuni Center ❑ West Hawaii Civic Center ❑Other: Parking Area Stall Number ---------------------------- Please type-or-print above information) RETURN ORIGINAL FORM TO THE DEPARTMENT OF PUBLIC WORKS FOR STALL ASSIGNMENT FIRST APPROVED: Public Works Authorized Signature Date Distribution: Original - Controller, County of Hawaii Copy - Employee Copy - Department of Public Works County of Hawai'i is an Equal Opportunity Provider and Employer.