APPENDIX E
PAYROLL DEDUCTION AUTHORIZATION
PLEASE PRINT
Last Name: First Name: M.L:
Address:
Street
City State Zip Code
Home Phone Cell Phone
Home/Non-School Email Address
School: Date:
TO NASHUA BOARD OF EDUCATION:
Thereby authorize you to deduct UNION dues from my earnings with the next paycheck and continuing in
equal installments in an amount equal to the UNION dues as set by the membership in accordance with
provisions of the Constitution of the Nashua Teachers’ Union. This amount shall be paid the Treasurer of the
Nashua Teachers’ Union, Local 1044, AFT, AFT-NH, AFL-CIO. This authority shall remain in full force and
effect for all purposes while I am employed in this school system, or until revoked by me in writing between
September 1% and September 15" of any given year.
EMPLOYEE SIGNATURE
STATUS: Part-time Continuing Sub Chapter I School Nurse
Federally Funded Regular (Contract) School Psychologist:
Return this form to:
Nashua Teachers’ Union
7C Taggart Drive
Nashua, NH 03060
Due, contributions, or gifts to the Nashua Teachers’ Union are not deductible as charitable
contributions for federal income tax purposes. Dues paid to the Nashua Teachers’ Union, however,
may qualify as business expenses, and may be deductible in limited circumstances subject to
various restrictions imposed by the Internal Revenue Code.
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