Support the Chaplaincy

I hereby authorize my employer to deduct from my paycheck the amount entered above on this form to be made from my first check of the month. This deduction is to be deposited to the Spokane County Chaplaincy, PO Box 18752, Spokane, WA 99228, for each first of the month payroll following receipt of this authorization. This Authorization will remain in effect until written notice from me to discontinue the payroll deduction is submitted.