TO:       PAYROLL DEPARTMENT, SODA SPRINGS SCHOOL DISTRICT #150

PLEASE CONSIDER THIS MEMO FORMAL AUTHORIZATION TO DEDUCT $____ PER MONTH FROM MY PAYCHECK.

    THESE FUNDS ARE TO BE USED FOR PROJECTS AT:

                SODA SPRINGS HIGH SCHOOL

                SODA SPRINGS JUNIOR HIGH (TIGERT MIDDLE SCHOOL)

                HOWARD E. THIRKILL PRIMARY SCHOOL

                CARIBOU HIGH SCHOOL

   FUNDS TO BE USED FOR:

                PROJECTS WHERE THEY ARE MOST URGENTLY NEEDED

                THE SPECIFIC PROJECT LISTED BELOW:

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                            SIGNED  ________________________

                     SOCIAL SECURITY #  ________________________

                              DATE  ________________________