APPENDIX A
NASHUA PUBLIC LIBRARY EMPLOYEES- LOCAL 4831
PAYROLL DEDUCTION AUTHORIZATION
Effective Date
Last Name First Name Middle Initial
(Please Print)
Street Address City/Town
State 7 Zip Code
Mailing Address (if different)
Home Phone Number Home Email
Library Branch/Department Job Title
Nashua Public Library Employees Local #4831, Federation of Public Employees
I hereby authorize you, according to arrangements agreed upon with the above organization,
to deduct from my salary and transmit to said organization, dues as certified by said
organization. I hereby waive all right and claim to said moneys so deducted and transmitted
in accordance with this authorization, and relieve the Board of Trustees and all its officers
from any liability therefore. I revoke any and all instruments heretofore made by me for such
purposes while I am employed in the Public Library System, or until revoked by me in
writing within fifteen (15) days after my anniversary date by delivering said written
revocation to the Human Resources/ Pay roll Department and the Union.
Member’s Signature Dated
Dues paid to the Nashua Public Library Employees Local #4831, FPE/AFT, may not be deductible
for federal income tax purposes; however, under limited circumstances, dues may qualify asa
business expense.
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