ࡱ> {}zg bjbj`` 8 x\ x\ VV8:N8MjjjjL$L$L$LLLLLLL$RORLL$##|L$L$LVVjP L&&&L$vVjVljL&L$L&&nEP,Hj0`$^OG LM08MoGS %pS@HH8S/ItL$L$&L$L$L$L$L$LL%pL$L$L$8ML$L$L$L$SL$L$L$L$L$L$L$L$L$ > :  Revocation of Electronic 1098-T Consent Form ______________________ ______________________ First Name Last Name ______________________ ______________________ Student/Gothic Id Number Email Address I, the above named student hereby withdraw my consent to receive IRS Form 1098-T electronically through Heartland ECSI and/or NJCU. If you wish to no longer consent to electronic delivery of the Form 1098-T, a paper copy will be printed and mailed. You will be responsible for updating your address on-line in GothicNet or at the Office of the Registrar. This request for revoking the electronic delivery of the 1098-T will be void if I later choose to re-enroll through Heartland ECSI eConsent. ________________________________________________________________________________________ Student Signature Date of Signature Please mail, email or fax this request to the contact information listed above. The Office of Student Accounts will process and accept your request to revoke the electronic delivery of your IRS 1098-T form. The staff member responsible for the acceptance will return a signed copy of this form to you at your NJUC email address and will indicate the date the revoke of eConsent took effect. Revoke in effect as of:_______________________________ _________________________________________________________________________________ Printed Name and Signature of Office of Student Accounts Representative      Office of Student Accounts 2039 Kennedy Blvd- ϲͼ City, NJ 07305 Hepburn Hall Room 106 Tel: 201-200-3045 Fax: 201-200-2049 Email:  HYPERLINK "mailto:Bursar@njcu.edu" Bursar@njcu.edu Website: www.njcu.edu/bursar  ./0`jq|V b k | 8 ļĵڪ|qia]a]a]ah+j8jh+j8Uh@gh e5h@gh8BOJQJh@gOJQJh8Bh8BOJQJh8Bh@gOJQJh8BOJQJh OJQJh@gh@gOJQJ h@gh@gh@gh@g5h@gh@gCJ(aJ(h@gh@gCJ aJ h@gh@gCJOJQJaJh`F5>*CJ(aJ(hcca hH5CJ$/0`d C D , f g dxgd@g & F dgd@g dgd@g d,gd@gd,gd@g d,gd@gdgd@g $d,a$gd@ggd9gdag h * + } +C{$a$gdp L$a$gd{gd{gd ed,gd@g )*CVWh{wldh@gh e5h{h{B*phjhH\HB*Uphh{ahp L0Jjhp LU hH\HhH\HhH\Hht^* h{h{hp Lhp Lhp L5 hD_5h!h{jhH\HUmHnHujhHUmHnHujhp LUmHnHujhD_UmHnHuh+j8!gd e$a$$a$gd{61h/R :pW:/ =!"#$%@ @bDdg.h  C DA,2016-NJCU-Logo_561-WMbaDj=A+ab\`aDnXaDj=A+ab\PNG  IHDRDsRGBgAMA a pHYs+tEXtSoftwareAdobe ImageReadyqe<`IDATx^d}l׊`%G#p, c(N4 + Fî HAUf0JѰ^;ZTLF [3BX(Th㍐В~=t>9FON"EDDD(>ƒ" ɲ --^ѻ-G/VSG`nM$JDDDd^P`@ZK Yv_wc}{J6Kz95 ||YKX<ҧzj&FhnkAd;h_ `^!T M;|~Ζ"""~9z+ 띵,:@pkC<;ys^%un޴%u9bR4EDDDچcq!ȑ'A .c(yn{0NR_^Y4)5"b|:~J|4MDDDڊW.ߵ3E^9KwaӽMiw`ü*OUCR؜G1bg)i#  Qqi}9'T6oxbbb 2q)v+nS ]Cnj-hmď؏ !*Jiz""""mBQ@\9RZ0o.' 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