If you believe that a payroll check issued to you has been lost or stolen, you would use this form to initiate a stop payment. 

All efforts should be made to locate this check before your request is submitted:

Once the stop is placed, the check becomes VOID.
The check cannot be cashed and must be returned to the Payroll office if received after the stop payment is issued.
A replacement check will be issued in 7-10 working days.

Form Instructions

Complete the following:
- Your Name
- Social Security Number
- Phone Number
- Check Number
- Check Date

Provide the following:
- Reason for Stop Payment

Sign and Date the Form

Bring this form to the Payroll Department in CSB 244