TSA Adjustment Invoice

This invoice is for a "Tax Sheltered Annuity Contribution Adjustment." It must be requested by the employer.
invoice 1 page 001
1  -  Statement number ending in "TA" indicates this is a "Tax Sheltered Annuity Adjustment" contribution invoice.
2  -  This is the TSA dollar amount due for this listed member "John Smith" based on the salary (dollar or percentage) change requested by the member.