AUTHORIZATION FOR PAYROLL DEDUCTION. I hereby authorize my employer and/or Sound Transit to withhold monthly dues and/or representation fees and to forward those funds to my exclusive bargaining representative, Local Union No. , AFL-CIO. I understand that this authorization will go into effect within 30 days of receipt. I also understand it will take 30 days on receipt of written notification to terminate this authorization. Date: Print Name: Social Security Number: Signature:
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Samples: Central Puget Sound, Central Puget Sound, Central Puget Sound