TO:


FR:


SS#:

MONTEBELLO TEACHERS ASSOCIATION


______________________________________


__________________________________

Mailing Address:


__________________________________________________________________


__________________________________________________________________


Please refund to me any amounts that I may be eligible to receive from the MTA Trust
fund due to MTA dues payments while employed with the Montebello Unified School
District.


I am no longer employed by the Montebello Unified School District or a Bargaining
Unit Member paying dues to the Montebello Teachers Association.


_______________________________________________________

Signature Date

PLEASE NOTE:


Refunds are not made until after the last payroll period and the roster has been
checked for deductions. We must also verify employment status.


Temporary Contract teachers not being rehired will be issued checks the first week of
October.


Check # ____________


Amount ___________

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