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<br />CITY OF LA PORTE VACATION LEAVE DONATION <br />PROGRAM <br /> <br />Vacation Leave Waiver and Donation Authorization Form <br /> <br />Having read and understood the City of La Porte Vacation Leave Donation Program <br />policy statement, and subject to the terms and conditions set forth therein, I hereby <br />voluntarily waive my entitlement to accumulated vacation time and donate <br />hours of my accrued vacation benefit on the condition that the equivalent dollar value of <br />the hour( s) I donate is paid by the City of La Porte, under the City of La Porte Vacation <br />Leave Donation Program, to the employee I have identified below. I understand that upon <br />submission of this form I cannot control the timing of the deduction of the donated hours <br />from my vacation leave balance. I further understand that donation of Vacation Leave is <br />not tax deductible. NOTICE: Donated Vacation Leave for an identified employee will be <br />administered on a first in, first out, basis. <br /> <br />Donor's name (print): <br /> <br />(M.!) <br /> <br />(Last) <br /> <br />(F irst) <br /> <br />Donor's Social Security Number: <br /> <br />Donor's Department Name: <br /> <br />Donor's Signature: <br /> <br />Date: <br /> <br />EMPLOYEE TO RECEIVE DONATION: <br /> <br />Print name: <br /> <br />1-04-07 <br />