Vacation Applicant Deduction AMERICAN MARITIME OFFICERS VACATION PLAN P.O. Box 35, Dania Beach, FL 33004 Tel: (954) 920-4247 (800) 348-6515 Ext. 15 Fax: (954) 926-7274 www.amoplans.com Email: [email protected] APPLICANT’S DEDUCTION AUTHORIZATION FOR INITIATION FEES, DUES, & FINES TO THE AMERICAN MARITIME OFFICERS I_____________________________________________, hereby (Please Print) authorize and direct American Maritime Officers Vacation Plan to deduct from vacation benefits due to me, monies due and payable by me as initiation fees, dues and fines to American Maritime Officers. I authorize said deduction to be made from any vacation payment made to me and to be forwarded by the American Maritime Officers Vacation Plan to the American Maritime Officers at 601 S. Federal Hwy, Dania Beach, Florida, 33004. ¹ This authorization is unconditional and, binding upon me, and may not be amended, rescinded, or terminated without the authorization of the Secretary/Treasurer of American Maritime Officers. ¹ While Dues/Initiation fees and fine(s) to the American Maritime Officers are not taxable for Federal income tax purposes; they may be tax deductible under other provisions of the Internal Revenue Code. Name First Last Applicant SignatureLast 4 of SSNDate MM slash DD slash YYYY
