Assignment and Authorization Request (Vacation) – LIUNA

I hereby assign to Local Union No. 1329, of the Laborers’ International Union of North America, such amounts from my wages as shall be required to pay an amount equivalent to the initiation fees, readmission fees, membership dues, and related assessments, as the Union may establish from time to time.

My Employer is hereby authorized to deduct such amounts from my wages and pay the same to the Local Union and/or its authorized representative. This authorization applies to my present Employer and all my future Employers. This authorization shall become effective upon its execution. This authorization shall be irrevocable for a period of one (1) year, or until termination of the Collective Bargaining Agreement in existence between my Employer and the Union, whichever occurs sooner. I agree and direct that this authorization shall be automatically renewed and shall be irrevocable for successive periods of one (1) year each, or for the period of any subsequent agreement between my Employer and the Union, whichever shall be shorter, unless written notice is given by me to my Employer and the Union not more than twenty (20) days and not less than ten (10) days prior to the expiration of each one (1) year period, or of each Collective Bargaining Agreement between my Employer and the Union, whichever occurs sooner. This check-off authorization shall continue irrespective of my membership in the Union or any union-security clause or obligation contained in the Collective Bargaining Agreement.

This assignment has been executed on(Required)

Name

First Last

Signature

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Employer(Required)

Telephone Number(Required)

Cell Phone Number(Required)

Email(Required)

SSN

DISABLED - A representative from Local 1329 will call you to confirm you’re your information after submitting the request form.

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Union dues are not deductible as charitable contributions for Federal income tax purposes. However, they may be tax deductible under other provisions of the Internal Revenue Code. Union dues may qualify as business expenses, job-related expenses, or other “unreimbursed employee expenses” to the extent permitted by the Internal Revenue Service.