Municipal Employees’ Annuity and Benefit Fund of Chicago

Annuitant Deduction Authorization

Illinois Public Employees Retiree Chapter 31
American Federation of State, County & Municipal Employees
615 South Second Street, P.O. Box 2328, Springfield, IL 62705-2328

Municipal Employees’ Annuity and Benefit Fund of Chicago (MEABFC)

First Name

Middle Name

Last Name

Street Address

Apartment, Suite, etc.

City

State

ZIP/Postal Code

Social Security Number (Last 4 digits only)

(Required by the retirement system)

Birth Date

Retirement Date

If Surviving Beneficiary of Retiree, Check Here

Beneficiary Name:

First Name

Middle Name

Last Name

Personal Email Address

Home Phone

Cell Phone †

† Message and data rates apply. Reply STOP to unsubscribe. By providing your cell phone number you consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME and its affiliated labor, political and charitable organizations on any subject matter. Your carrier’s rates may apply. You may modify your preferences by emailing [email protected].

Authorization

I hereby authorize the Municipal Employees’ Annuity and Benefit Fund of Chicago to deduct each month the amount certified by the Retiree Chapter as the current rate of dues. This deduction is to be turned over to the Public Employees Retiree Chapter 31, AFSCME. I understand that I may cancel this authorization at any time by writing the Municipal Employees’ Annuity and Benefit Fund of Chicago, 221 North LaSalle Street, Chicago, IL 60601-1294.

Signature

My electronic signature is a binding and valid signature. By signing here I agree to all of the terms and conditions set out in this authorization, which apply to my membership, dues payments and, if applicable, PEOPLE payments.

Subchapter

For office use only