Charitable Contribution Authorization Form

STAR 6

STAR 6 FOUNDATION

(Recommended contribution; $5.00)

The STAR 6 Foundation is a charitable organization and recognized by the IRS as a non-profit 501(c) (3). All contributions and donations are tax deductible. Tax ID# 20-3255899

STAR 6 Foundation Contribution Amount (USD)

I agree to contribute the above amount per pay period.

CALIFORNIA PEACE OFFICER MEMORIAL

CALIFORNIA PEACE OFFICER MEMORIAL FOUNDATION

(Recommended contribution; $5.00)

The California Peace Officer Memorial Foundation is a charitable organization and recognized by the IRS as a non-profit 501(c) (3). All contributions and donations are tax deductible. Tax ID# 95-4350983

California Peace Officer Memorial Contribution Amount (USD)

Please enter a number greater than or equal to 0.

I agree to contribute the above amount per pay period.

SACRAMENTO POLICE SHERIFF MEMORIAL

SACRAMENTO POLICE SHERIFF MEMORIAL FOUNDATION

(Recommended contribution; $2.00)

The Sacramento Police/Sheriff Memorial Foundation is a charitable organization and recognized by the IRS as a non-profit 501(c) (3). All contributions and donations are tax deductible. Tax ID# 68-0267352

Sacramento Police Sheriff Memorial Foundation

Please enter a number greater than or equal to 0.

I agree to contribute the above amount per pay period.

Authorization and Acknowledgement

I hereby authorize deductions to be made from my bi-weekly paycheck in the amount specified above to the charitable organizations I have elected. This authorization will remain in effect until cancelled by the organization at my written request.(Required)

I accept the Terms and Conditions.

First Name(Required)

Last Name(Required)

Signature(Required)

BY SIGNING, YOU AGREE TO THE TERMS AND CONDITIONS AS SET FORTH ABOVE.

Enter your email address below to receive your Charitable Contribution Authorization form copy:

You must enter a dollar amount for the STAR 6 Foundation Contribution

You must enter a dollar amount for the California Peace Officer Memorial Contribution

You must enter a dollar amount for the Sacramento Police Sheriff Memorial Foundation