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Promissory Note - Form

This promissory note acknowledges that the employee was overpaid by their employer for a total gross amount of $____ during the period of ________. The employee agrees to repay the net amount of $____ through semi-monthly payroll deductions. The employee authorizes the employer to deduct installment payments from paychecks until the full amount is repaid by an agreed upon date. If the employee resigns or is terminated before full repayment, the outstanding balance will be due immediately and deducted from final pay or accrued vacation pay.

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507 views1 page

Promissory Note - Form

This promissory note acknowledges that the employee was overpaid by their employer for a total gross amount of $____ during the period of ________. The employee agrees to repay the net amount of $____ through semi-monthly payroll deductions. The employee authorizes the employer to deduct installment payments from paychecks until the full amount is repaid by an agreed upon date. If the employee resigns or is terminated before full repayment, the outstanding balance will be due immediately and deducted from final pay or accrued vacation pay.

Uploaded by

CloudKielGuiang
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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PROMISSORY NOTE

I, ____________, acknowledge that I was overpaid by my employer,


________________________, a total gross amount of $_____, during the period
________________. It is my obligation to repay the amount of $____ (gross pay less taxes), as
per the attached notification of Salary Overpayment. As consideration for my signing this
promissory note and agreeing that _____ may recover this amount through payroll deductions,
_____ agrees to allow me to repay this amount as described in this Promissory Note agreement.

I hereby promise to repay _____ the loan amount in semi-monthly installments, initially at the
rate of $____, beginning with the pay period ending _____________. By my signature below, I
hereby authorize _____ to deduct the established installment payments from my semi-monthly
paychecks until the completion of the repayment of the loan amount.

I expect to repay the full amount via payroll deduction. Should I fail to repay the full amount by
____date_________, I authorize _____ to recover the remaining amount in equal semi-monthly
payroll deductions starting on that date, so that the full amount is repaid no later than
___________________.

I acknowledge that this Promissory Note agreement does not alter the “at will” nature of my
employment with ______, and that I or ___________ may terminate the employment
relationship at any time, with or without notice or reason.

Any outstanding balance of the loan amount which is not satisfied by deductions, as outlined
above, will be due and payable immediately to __________, if I resign or am terminated from
employment with ________ for any reason prior to the completion of repayment of the loan
amount. Should I resign or be terminated from employment with _______ prior to the
completion of the repayment of the loan amount, by my signature below I hereby authorize
_____ to deduct the outstanding balance of the loan amount from my accrued but unused
vacation pay and/or from my final paycheck.

___________________________________ Date: _____________________


[Signature of Employee]

Washington, D.C. ) ss.

Subscribed and sworn to before me this ______ day of _____________________, 2007.

___________________________________
Notary Public
My Commission Expires:

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