Standard Form 1187
Revised June 1989
U.S. Office of Personnel Management / REQUEST FOR PAYROLL DEDUCTIONS FOR LABOR ORGANIZATION DUES
Privacy Act Statement
Section 5525 of the 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 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 a 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 you SSN is 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.

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NAME OF EMPLOYEE (Print, Last Name, First, Middle) IDENTIFICATION NO. (Social Security or Other)

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HOME ADDRESS (Street and Number) (City and State) (ZIP Code)

AGENCY (Include Bureau, Division, Branch or other Designation)

DEPARTMENT OF TRANSPORTATION

FEDERAL AVIATION ADMINISTRATION

Section A—FOR USE BY LABOR ORGANIZATION

NAME OF LABOR ORGANIZATION (Indicate local, branch, lodge or other appropriate identification)

National Native American/Alaska Native (NAAN) Coalition for Federal Aviation Employees- NC0000

069

I hereby certify that the regular dues of this organization for the above named member are currently established at $ 8.00 per (biweekly pay period.)

SIGNATURE AND TITLE OF AUTHORIZING OFFICIAL DATE

Ranelle Yazzie, National Treasurer, NAAN

Section B—AUTHORIZATION BY EMPLOYEE

I hereby authorize the above named agency to deduct from my pay each pay period, or the first full pay period of each
month, the amount certified above as the regular dues of the Federal Managers Association, Chapter # 185, and to remit such amounts to that labor organization in accordance with its arrangements with my employing agency. I further authorize any changes in the amount to be deducted, which is certified by the above named labor organization as a uniform change in its dues structure. I understand that this authorization, if for a biweekly deduction, will become effective the pay period following its receipt in the payroll office of my employing agency; and that, if for a monthly deducting , it will become effective the first full pay period of the calendar month following its receipt in the payroll office of my employing / Agency. I further understand that revocation forms, Standard Form No. 1188; Revocation of Voluntary Authorization for Allotment of Compensation for Payments of Labor Organization Dues, are available from my employing agency and that I may revoke this authorization at any time by filing such a revocation form or other written revocation request with the payroll office of my employing agency. Such revocation will not be effective however until the first full pay period which begins on or after the next established cancellation date of the calendar year after the cancellation is received in the payroll office.
Contributions or gifts (including dues) to the labor organization shown at left are not tax deductible as charitable contributions. However, they may be tax deductible under other provisions of the Internal Revenue Code.

SIGNATURE OF EMPLOYEEDATE


FOR COMPLETION BY AGENCY ONLY - The above named employee and labor organization meet the requirements for dues withholding. (Mark the appropriate box. If “YES”, send this form to payroll. If “NO”, return this form to the labor organization.) / YES NO

SEND TO: NAAN PO BOX 702017, WEST VALLEY CITY, UT 84170

Native American/Alaskan Native (NAAN)

Coalition of Federal Employees

MEMBERSHIP APPLICATION

  • SERVICE AREA/LINE OF BUSINESS: ______
  • NAME: ______
  • WORK ADDRESS:______
  • CITY: ______STATE: ______ZIP CODE: ______
  • PHONE: WORK: ______HOME ______
  • HOME ADDRESS: ______
  • CITY: ______STATE: ______ZIP CODE: ______

CHECK ONE: [ ] New [ ] Renewal [ ] Payroll Deductions [ ] Associate [ ] Address Change

Both $208.00/year$8.00 per pay period $45.00/year

: [ ] Student [ ] Corporate [ ] Retired under the age of 65 [ } Retired over the age of 65

$35.00 $350.00$130.00/year $65.00/year

  • Please enclose a check, money order, or completed dues withholding form with this application.

MAIL COMPLETED APPLICATIONS TO: National NAAN Coalition

P.O. Box 702017

West Valley City, Utah 84170

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PURPOSE: The national Native American/Alaskan Native (NAAN) Coalition serves as an advocate for occupational diversity issues affecting minorities and women of the Federal Aviation Administration.

OBJECTIVES:NAAN is committed to:

  • Promoting equal opportunity by assisting in recruitment development, retention, and promotion of minorities and women.
  • Educating members and non-members concerning rights and personnel actions.
  • Providing a liaison between special emphasis groups, FAA employees, supervisors, and managers.
  • Establishing a nationwide communication system among members.
  • Improving employee/management relations.
  • ORGANIZATION: NAAN is an employee association officially recognized by the Department of Transportation and the Federal Aviation Administration. NAAN is a non-profit organization.

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NATIONAL OFFICERS:

  • President Ranelle Yazzie, Tel. No. (801) 320-2312
  • 1st Vice President: Stephanie Bell, Tel No. (609) 485-8818
  • 2nd Vice President: Edwin Doney, Tel No. (317) 227-5736
  • Treasurer: Teresa L. Miller, Tel. No. (425) 227-1830
  • Secretary Sharon Padilla, Tel. No. (907) 271-2915
  • Public Affairs/Corporate Membership: Jonny Shay, Tel. No. (401) 267-3633
  • Conference Coordinator: Vacant