Last Name:

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Address:

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City/State/Zip:

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Mail Handler Seniority Date:

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Retirement Date:

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Facility (circle one)

Cedar Rapids  DSM P&DC   NDC   Waterloo

 In accordance with Article XIV section 1 of Local 333 by law that states,

“Upon retirement, any regular member who has been continuously enrolled for payroll dues deductions for the two (2) years immediately prior to retirement shall receive a gift of a watch or one hundred dollars ($100.00)”

Place an X next to the Retirement Gift of your choice

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Retirement Watch

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Cash Option

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Member Signature                                                                        Date