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Exhibit O — NYSUT Benfits 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