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2/24/2021 12:34:37 PM
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COUNTY OF HAWAII <br /> H I LO, HAWAII <br /> NOTICE OF TERMINATION OF COUNTY FACILITY PARKING ASSIGNMENT <br /> Employee's Name Employee # <br /> Department <br /> I hereby serve notice of termination of my lot assignment and its related salary assignment for <br /> my parking stall fee, effective <br /> (last day of month and year) <br /> Employee's Signature <br /> Date <br /> Check one: <br /> ❑County Building ❑Aupuni Center F-1 West Hawaii Civic Center ❑Other: <br /> PARKING AREA STALL NUMBER <br /> --- - - - - - --- - - - - - - ---------------------------------------------------------------------------------- <br /> PLEASE RETURN ORIGINAL FORM TO THE DEPARTMENT OF PUBLIC WORKS <br /> TWO WEEKS PRIOR NOTICE REQUIRED <br /> APPROVED: <br /> Public Works Authorized Signature Date <br /> Distribution by Public Works: <br /> Original - Controller, County of Hawaii <br /> Copy - Department of Public Works <br /> County of Hawai'i is an Equal Opportunity Provider and Employer. <br />
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