APPENDIX A
DUE DEDUCTION CARD FACSIMILE
AUTHORIZATION FOR CHECK-OFF OF DUES
| hereby direct the Comptroller of the City of Nashua, New Hampshire, to deduct uniformly
assessed Association dues from my weekly earnings. The Comptroller is directed to remit
such deductions to the designated officer of the Nashua Police Supervisors Association.
| understand that this authorization for check-off of dues will remain in effect as long as !
remain in the bargaining unit, unless revoked by my giving written notice to the City
Comptroller.
/ further understand that if such notification is given, dues may continue to be deducted for a
period of thirty (30) days thereafter.
| authorize the amount of $ per week be deducted from my payroll check.
Date Signature
Social Security Number
28
