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Exhibit O — NYSUT Benefits Payroll Deduction

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_____________________________________________________________________________________
Last Name                             First Name                 M.                      Social Security No.


_____________________________________________________________________________________

Street Address        City                    State               Zip                Home Telephone No.


The amount of deduction will be determined by the NYSUT Benefit Trust based on the programs chosen.


To the Employer:

I hereby authorize you to deduct from each of my salary checks the deduction necessary for the purpose of the NYSUT Benefit Trust. I understand that this authorization may be revoked at any time by written notice to you.


Signature of Employee______________________________ Date                     

NEW YORK STATE UNITED TEACHERS BENEFIT TRUST
800 Troy-Schenectady Road
Latham, NY 12110-2455