Exhibit I — Cope Deduction Authorization

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EMPLOYER COPY

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AUTHORIZATION FOR VOLUNTARY DEDUCTION
UFT COPE COMMITTEE, P.O. BOX 1005, New York, NY 10274-1005

$2.00
AMOUNT PER MONTH

_________________________
SOCIAL SECURITY NUMBER

 



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LAST NAME                                                  FIRST                                     INITIAL


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Address_______________________________________________________
STREET AND NO.                           CITY                           STATE                        ZIP
 

I hereby authorize regular deductions from my earnings in the amount specified hereon as a voluntary contribution to be paid to the treasurer of the UFT COPE Committee, to be used in accordance with the Bylaws of the Said Committee and applicable law for the purpose of making political contributions and expenditures. My contribution is voluntary, and I understand that it is not required as a condition of employment, and that I may revoke this authorization at any time by giving written notice to the treasurer of the UFT COPE Committee and/or my payroll office, such revocation being effected when accepted into the employer's payroll system. This authorization supercedes all previous authorization.
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A    Contributions or gifts to Vote/COPE are not deductible as charitable contributions for federal income tax purposes


SIGNATURE                                                                                      DATE



RN REPRESENTATIVE                 DATE              EMPLOYER              BOROUGH

A copy of the UFT COPE Committee Report is filed with New York State Board of Elections and is available from the Board, Empire State Plaza, Albany, NY 12223

 

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