Individual Authorization Form
Voluntary Payroll Deduction
Machinists Non-Partisan Political League

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Machinists Non-Partisan Political League
Political Action Wage Deduction Authorization Card


I, __________________________________, ____________________________________________ hereby
           (Name of Employee)                              (Clock/Social Security No.)

authorize and direct ______________________________________________________ to deduct monthly
                                                                     (Name of Employer)

from my wages the sum of $________________ and forward this amount to the Treasurer of the Machinists Non-Partisan Political League at 9000 Machinists Place, Upper Marlboro, MD 20772.

I have executed this wage deduction authorization voluntarily without any coercion, duress, or intimidation and none of the monies deducted are a part of my dues or membership fees to the local union. This authorization and the making of payments to MNPL are not conditions of membership in the Union or of employment with the company and I understand that the money will be used by MNPL to make contributions and expenditures in connection with Federal Elections. This authorization shall remain in full force and effect until revoked in writing by me. I also understand that my contributions or gift to MNPL is not deductible as a charitable contribution for federal income tax purposes.


________________________________________                            ________________________________________
            Name (Signature)                                                                                                         Date


            Street Address                            City                                       State                                 Zip Code


________________________________________                             ________________________________________
            Position Title/Location                                                                                  TCU Lodge Number

Please return this form to:
MNPL, 3 Research Place, Rockville, Maryland 20850

Internet form mnpl6760

Return to the Brotherhood Railway Carmen Home Page

Published by Heartland Lodge 6760
Fort Wayne, Indiana, USA, October 7, 1998
Revised August 29, 2012