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I authorize deduction number 59 from my paycheck for "Santa Rosa City Employees' Association" dues. This authorization will remain in effect until Payroll is notified in writing to cancel. Name: ________________________________________ Last 4 of Social Security Number:____________________ Date: _________________________________________ Signature: _____________________________________ Return this enrollment form to the attention of Payroll in the Administrative Services Department located in the City Hall Annex.
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