Common use of PAYROLL DEDUCTION AUTHORIZATION FORM Clause in Contracts

PAYROLL DEDUCTION AUTHORIZATION FORM. By (Please Print) Last Name First Name Middle Name To: Name of Employer Department Effective , 20 , I hereby request and authorize you to deduct from my earnings each payroll period an amount sufficient to provide for the regular payment of the current rate of monthly: (check one) 1) union dues; or 2) service fees as established by the Police Officers Association of Michigan. The amount deducted shall be paid to the Treasurer of the Police Officers Association of Michigan. Employee's Signature Street Address City and State

PAYROLL DEDUCTION AUTHORIZATION FORM. By (Please Print) Last Name First Name Middle Name To: Name of Employer Department Effective , 20 , I hereby voluntarily request and authorize you to deduct from my earnings each payroll period an amount sufficient to provide for the regular payment of the current rate of monthly: (check one) 1) union dues; or 2) service fees as established by the Police Officers Association of Michigan. The amount deducted shall be paid to the Treasurer of the Police Officers Association of Michigan. Employee's Signature Street Address City and State