CENTRAL NEW MEXICO COMMUNITY COLLEGE 

SOCIAL SECURITY NUMBER	NAME (LAST, FIRST, MIDDLE)	DEPARTMENT

 SALARY REDUCTION AUTHORIZATION

Pursuant to the provisions and conditions set forth on the bottom of this page, I hereby request and authorize the Central New Mexico Community College (CNM) Payroll Department to reduce my salary by $ _________________ per pay period and direct the amount of such reduction to the insurance/mutual fund company indicated below.

Employee Contribution $____________________________ (per pay period) 

CHECK ALL THAT APPLY:            Change in deduction amount           Increase              Decrease

              Change in Company                              Additional Company                        New 403(b)          

EFFECTIVE DATE OF CHANGE: ________________________________________

INSURANCE COMPANY/MUTUAL FUND TO RECEIVE 403(b) FUNDS:

(Printed)

(Printed)

(Print Name of Investment Advisor)                                                                                                                        (Phone #) 

CANCELLATION REQUEST:  PLEASE CANCEL MY PREVIOUS TAX DEFERRED RETIREMENT CONTRIBUTION TO:  ___________________________________       ______________________________          _________             NAME OF COMPANY(IES)                                                     EMPLOYEE SIGNATURE                        DATE

 SALARY REDUCTION AGREEMENT/AMENDMENT TO EMPLOYMENT CONTRACT

It is agreed that the wages earned or contract of employment between my Employer and the below-named Employee is amended effective the first day of the month following the below date.  Employer is requested and authorized by Employee to reduce the amount of salary payments due Employee and to direct the amount of such salary reduction to the company indicated above for the purchase by that company of a 403(b) account for Employee under the provisions of Sec. 403(b) of the US Internal Revenue Code and other applicable law.  By signature of Employee below, receipt of copy of this Salary Reduction Agreement/Amendment to Employment Contract on the below date is hereby acknowledged. 

It is also agreed that this Salary Reduction Agreement/Amendment to Employment Contract shall apply to any future wages/employment contracts or any amendment to the present or to any future wages/employment contract providing only that the Employee has the right at any time to revoke this agreement.  Employee agrees that my Employer shall in no way be liable to Employee or their successors for any money damages which might arise from federal or state tax consequences of my participation in a 403(b) retirement account and consistent therewith.  Employee further agrees to save and hold harmless my Employer from any such money damages. 

                                                                                Employee
Date: ___________________________       Signature: __________________________________________________