Payroll Deduction Authorization

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Payroll Deduction Authorization Printed Name: _________________________________________________________________ BSU ID#____________ Mailing Address: ______________________________________ City: ___________________ State: ____ Zip: _________ Preferred email address: _________________________ Date: ________________________________________ Signature: _________________________________________________________________________________ Return completed form to BSU Foundation-AL 237 or by email to [email protected]. Ball State University (D53) Please allocate my gift(s)* as follows: ____ The Ball State Fund (most vital and emerging needs) ____ Cardinal Varsity Club ____ School/College/Department of ________________________________________________________ ____ University Libraries ____ Other (see below for IPR and WIPB) ____________________________________________________ *Your gift will be split equally among each fund you select unless otherwise noted. I authorize Ball State University Foundation to deduct $_________ per pay period, beginning ____/____/____ and ___ in addition to my current pledge (any existing pledge outside of IPR & WIPB will be cancelled if left unchecked) ___ continuing until changed or discontinued in writing by me, or ___ stopping automatically after a pledge of $_________ has been reached. ___ stop deduction for designation _______________________________________. Indiana Public Radio (D50) WIPB Public Television (D51) Please allocate my gift to Indiana Public Radio. Please allocate my gift to WIPB-TV. I authorize Ball State University Foundation to deduct $_____ I authorize Ball State University Foundation to deduct $____ per pay period, beginning ____/____/____ and per pay period, beginning ____/____/_____ and ___ continuing until changed or discontinued in writing by me, or ____ continuing until changed or discontinued in writing by me, or ___ stopping automatically after a pledge of $__________ ____ stopping automatically after a pledge of $____ has has been reached. been reached. ___ stop deduction for designation __________________. ___ stop deduction for designation __________________. THANK YOU FOR YOUR GIFT TO SUPPORT BALL STATE UNIVERSITY Payment Schedule 12 Month 10 Month Annual Gift Monthly Deduction Biweekly Deduction Monthly Deduction $2,500 $208.34 $96.15 $250.00 $1,000 $83.34 $38.46 $100.00 $750 $62.50 $28.85 $75.00 $500 $41.67 $19.23 $50.00 $400 $33.34 $15.38 $40.00 $300 $25.00 $11.54 $30.00 $250 $20.84 $9.62 $25.00 $200 $16.67 $7.69 $20.00 $150 $12.50 $5.77 $15.00 $100 $8.34 $3.85 $10.00 $75 $6.25 $2.88 $7.50 $50 $4.17 $1.92 $5.00 Indiana Tax Credit The State of Indiana offers a special tax credit to tax payers in return for their support. When you make a gift to Ball State, you can receive a tax credit for 50 percent of your gift up to a maximum of $200 for joint returns and a maximum credit of $100 on single tax returns. You must use Indiana State income tax form CC-40 to claim your credit. Note – this information is not intended as legal or tax advice. Please consult your tax advisor. Planned Giving ___I would like to learn more information about planned giving opportunities at Ball State University. ___I have included Ball State University in my estate planning. .

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