AUTHORIZATION FOR EMPLOYEE ORGANIZATION DEDUCTION

I HEREBY AUTHORIZE THE STATE OF NEW JERSEY TO MAKE BI-WEEKLY DEDUCTIONS FROM MY SALARY IN THE AMOUNT OF 85% (OR FOR SUCH OTHER AMOUNTS AS MAY BE AUTHORIZED BY AMENDMENT TO THE DUES SCHEDULE OF THE ORGANIZATION) FOR DUES PAYABLE TO THE TREASURER OF THE EMPLOYEE ORGANIZATION DESIGNATED BELOW. I UNDERSTAND THAT THIS AUTHORIZATION SHALL REMAIN IN EFFECT UNLESS CANCELLED BY ME IN WRITING AND THAT SUCH CANCELLATION SHALL BECOME EFFECTIVE EITHER ON THE FIRST PAY DAY FOLLOWING JANUARY 1 OR JULY 1, IN ACCORDANCE WITH MY CURRENT NEGOTIATED CONTRACT.

NAME (INCL CHAPTER ANDIOR LOCAL) AND MALING ADDRESS AS IT APPEARS ON THE DIV. OF BUDGET AND ACCOUNTING APPROVED LIST.

Employee Organizaton

IBEW LOCAL 30
212 West State Street
Trenton, NJ 08608

SUBMIT THIS COMPLETED FORM TO YOUR DEPARTMENT'S PAYROLL CLERK FOR PROCESSING