аЯрЁБс>ўџ 35ўџџџ2џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅСq  Пbjbjt+t+ Э"AAЮ Сџџџџџџ]^^^^^^^Dмммм€\p$мoЖ ‚"""""6X$|јњњњњњњ$%єŠQ^""д^^"" ддд^"^"јЂА,^^^^јд$дј^^ј"”  К–ŠHТмм 4ј Standard Form 1188 Revised March 1979 Office of Personnel Management FPM Chapter 550CANCELLATION OF PAYROLL DEDUCTIONS FOR LABOR ORGANIZATION DUES Privacy Act Statement Section 5525 of Title 5 United States Code (Allotments and Assignments of Pay) permits Federal agencies to collect this information. This completed form is used to request that labor organization dues be deducted from your pay and to notify your labor organization of the deduction. Completing this form is voluntary, but it may not be processed if all requested information is not provided. This record may be disclosed outside your agency to: 1) the Department of the Treasury to make proper financial adjustments; 2) a Congressional office if you make an inquiry to that office related to this record; 3) a court or an appropriate Government agency if the Government is party to a legal suit; 4) an appropriate law enforcement agency if we become aware of a legal violation; 5) an organization which is a designated collection agent of a particular labor organization; and 6) other Federal agencies for management, statistical and other official functions (without your personal identification). Executive Order 9397 allows Federal agencies to use the social security number (SSN) as an individual identifier to avoid confusion caused by employees with the same or similar names. Supplying your SSN in voluntary, but failure to provide it, when it is used as the employee identification number, may mean that payroll deductions cannot be processed. Your agency shall provide an additional statement if it uses the information furnished on this form for purposes other than those mentioned above. 1. Name of Employee (Print or Type  Last, First, Middle)  FORMTEXT       2. Employee I.D. Number (Social Security or other)  FORMTEXT       3. Agency Name (Include Bureau, Division, Branch or other Designation)  FORMTEXT        4. Timekeeper Number  FORMTEXT       5. Name of Labor Organization  FORMTEXT        6. Cancellation Date  FORMTEXT       I hereby cancel my authorization for the deduction of dues for the above labor organization from my pay.* I understand that this cancellation will become effective on the first full pay period which begins on or after the next established cancellation date (indicated above) after this request is received in my agency payroll office. Signature of Employee  Date (Month, Day, Year)  FORMTEXT       (Submit copies 1 and 2 to the agency payroll office. Copy 1 is retained for payroll records and Copy 2 is forwarded by the payroll office to the labor organization in accordance with the arrangement between the agency and the labor organization. Copy 3 is retained by the employee.) 1 – Agency Copy 2 – Labor Organization 3 – Employee Copy 1 – Agency Copy 2 – Labor Organization 3 – Employee Copy V•–—7 " $ * J L š œ А В Д О Р Т Ф , . B D F P R T V X v ц ш ќ ў    > @ T V X b d f h j p љёыфљнфљфеЬЧЛЬАЬЧнљЬЧЄЬАЬЧљнљœЬЧЬАЬЧљнљЬЧ„ЬАЬЧљнфj\OJQJUjшOJQJU6CJOJQJjtOJQJUjOJQJUmHjOJQJUOJQJjOJQJU6CJOJQJ CJOJQJ CJOJQJ 5OJQJ5CJ OJQJ CJOJQJ4'FV•–—­78—˜њ ћ   " $ ˜ š ќќќќќїЩЦФТРРРРРРРРРќќќ$-$$–lжж0”џє œ*џџџџџџџџџџџџџџџџџџџџџџџџ$$$'FV•–—­78—˜њ ћ   " $ ˜ š Д О Т Ф * , F P T V X ц    < > X b f h j І Ј Т Ь а в д ў $(*,ЬЮаќўPZ^`bЭЮ-.Ž§§§§§§ћїѕѓѓ§§§ѓѓѓ§§§ѓѓѓћ§§ѓѓѓ§§§§ѓѓѓћ§§§ѓѓѓ§§§§ѓѓѓћѕ§§§§§§ѓѓѓћѓѓѓёяьяѓѓ    Rš Т Ф * , T V X ц    < > f h j І Ј а в д ў њїїїњм$їїњїїїїњТ„їїїњњїї$$–lжж”џќœ*$$–l4жж”џќœ*$$$p Є Ј Њ О Р Т Ь Ю а д $&(,ЬЮа68LNPZ\^`Ю-.љёшузшЬшуХљшуЙшЬшуљљХВХВёшуІшЬшёŸœ””œ5CJOJQJCJ CJOJQJjИOJQJU CJOJQJjDOJQJU CJOJQJjOJQJUmHjаOJQJUOJQJjOJQJU6CJOJQJ CJOJQJ(ў (*,ЬЮаќў46^`bЮ-ќїнлйлќќќќќќќќїЊллЇ$/$$–l4жж0”џ.œ*џџџџ$$–lжж”џќœ*$$$-.Ž§њ§§§$$/R Аа/ Ар=!Аа"Аа#о$ %АА€' 0/R Аа/ Ар=!Аа"Аа# $ %АА€= 0/R Аа/ Ар=!Аа"Аа# $ %АА€ P0ђАђађА= 0&P/R Аа/ Ар=!Аа"Аа# $а%АА€0ђ0*ђађАtDџџџџText1tDџџџџText2tDџџџџText5tDџџџџText3tDџџџџText1tDџџџџText3jDџџџџ [$@ёџ$NormalmH <@< Heading 1 $$@& 5OJQJ<AђџЁ<Default Paragraph Font2B@ђ2 Body Text CJOJQJ,,Header  ЦрР!, @,Footer  ЦрР!­‘ "џџџџ&"џџџџO"џџџџŽ"џџџџ#џџ­‘ ``````РРРРРРРРРРРРРРРУp  š ў -  Эйп"(s…ŸЋБдрц › Ї ­  Fдџ•€Fдџ•€Fдџ•€Fдџ•€Fдџ•€Fдџ•€Fдџ•€џџText1Text2Text5Text3Юt ‘ р)†В‘ Ю ‘ }Ю й ђ 9 R ‘ џџCharles T Crews*C:\TEMP\AutoRecovery save of Document2.asdCharles T CrewsA:\Standard Form 1188.docCharles T CrewsA:\Standard Form 1188.dotџ@кп(ђщкк.œ*L  €@€ € €€€$@G‡z€џTimes New Roman5€Symbol3& ‡ŸArial"ёˆаhтгffтгffа|VІ€A!ЅРДД€>0dŸџџStandard Form 1187Charles T CrewsCharles T Crewsўџр…ŸђљOhЋ‘+'Гй0Є˜ МШрьј ,8 T ` l x„Œ”œфStandard Form 1187tanCharles T CrewsharharStandard Form 1187Charles T Crews2arMicrosoft Word 8.0@@8 #ёѕР@„›kHТ@„›kHТ€AўџеЭеœ.“—+,љЎDеЭеœ.“—+,љЎ\ hp˜ ЈА ИРШа и їфSocial Security Administrationt1 Standard Form 1187 Title˜ 6> _PID_GUIDфAN{3DCFCCBE-61D9-11D5-BE85-400050E0A017} ўџџџўџџџ !ўџџџ#$%&'()ўџџџ+,-./01ўџџџ§џџџ4ўџџџўџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџRoot Entryџџџџџџџџ РF N“OHТР–Ѓ‹HТ6€Data џџџџџџџџџџџџ1TableџџџџџџџџWordDocumentџџџџЭ"SummaryInformation(џџџџџџџџџџџџ"DocumentSummaryInformation8џџџџџџџџ*CompObjџџџџjObjectPoolџџџџџџџџџџџџР–Ѓ‹HТР–Ѓ‹HТўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџ џџџџ РFMicrosoft Word Document MSWordDocWord.Document.8є9Вq