AUTHORIZATION FOR DUES DEDUCTION
THE STATE OF OHIO, UNIT 2 ASSOCIATION
c/o Lazarus & Lewis, LLC
30 Garfield Place, Suite 915
Cincinnati, Ohio 45202-4322
(513) 721-7300
I, the undersigned, hereby authorize my Employer to check off and deduct from my payroll an amount equal to dues, remitting directly to Lazarus & Lewis, LLC
(PLEASE PRINT)
Place of Employment _______________________________________________________
Name of Employee__________________________________________________________
Home Address _____________________________________________________________
City ___________________________________ Zip Code _________________________
Phone ____________________________________________________________________
Classification ______________________________________________________________
Signature _________________________________________ Date ___________________
E-mail_____________________________________________________________________