I hereby authorize my employer to deduct from my wages the sum of $0.10. per hour for each hour worked and to remit such amount to the Kentucky PAC of the International Union of Operating Engineers, Local 181, P.O. Box 34,Henderson, Kentucky 42419.
THIS AUTHORIZATION IS VOLUNTARILY MADE BASED ON MY SPECIFIC UNDERSTANDING THAT: The signing of this authorization card and the making of contributions to Kentucky PAC of the International Union of Operating Engineers, Local 181 are not conditions of membership in the union nor of employment with my employer and that I may refuse to do so without fear of reprisal I further recognize I may withdraw this authorization at any time upon written notice to my employer.
I am making a contribution to a fund-raising effort sponsored by Kentucky PAC of the International Union of Operating Engineers,Local 181, and acknowledge and wish for the Kentucky PAC of the International Union of Operating Engineers, Local 181 to use my contributions for political purposes, including but not limited to, the making of contributions to or expenditures on behalf of candidates for federal, state, and local offices and addressing political issues of public importance in Kentucky and Indiana, as well as for all other lawful purposes in the Kentucky PAC of the International Union of Operating Engineers, Local 181's interest.
Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and the name of employer of individuals whose contributions exceed $200 in a calendar year. Contributions or gifts to Kentucky PAC of the International Union of Operating Engineers, Local 181 are not deductible as charitable contributions for federal income tax purposes.