Florida Direct Deposit Form 3
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PLEASE READ AND CAREFULLY FOLLOW INSTRUCTIONS!
For a Start or Change all boxes must be completed;
do not leave information blank!

Please leave this area blank

This form will start, change, or stop direct deposit for all
payments received by you from the State of Florida. You may
not have direct deposit to more than one account at one time.

STATE OF FLORIDA
DIRECT DEPOSIT AUTHORIZATION
Alex Sink, Chief Financial Officer
PLEASE TYPE OR PRINT CLEARLY
Your Social Security Number

Last Name,

First Name

M.I.

Your Home Mailing Address (Number, Street)

City

State

Zip Code

Work Telephone

Other Telephone (home, cell, etc.)

(____)

(____)

Direct Deposit
Action Requested
(Check Only One)

(1) Start...............................
(2) Change..........................
(3) Name Change Only.......
(4) Stop ...............................

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†
†
†

For State of Florida Employees only.

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Account Type
(1) Checking .......................
(Check Only One)
(2) Savings ................