SURVIVORS'

BENEFIT TAX LIABILITY ACKNOWLEDGEMENT

EXCLUDED (Not Represented By Collective Bargaining AND RANK AND FILE BARGAINING UNIT 06 EMPLOYEES

This is an important announcement to all Excluded and Bargaining Unit 06 employees regarding Survivor's Benefit donations. The following information is not to discourage Survivor's Benefit donations but to notify you of a recent taxability concern. Under existing tax laws there may be a tax liability for the donor of Survivor's Benefits. Taxes will be at 25% for Federal and 6% for State. Social Security and Medicare taxes will be deducted if applicable. The Survivor's Benefit allows R06 and Excluded employees to donate leave credits (excluding sick leave) to an eligible employee who dies due to an illness or injury, which was not incurred in the line of duty. Donations of leave credits will only be accepted for 30-days following the approval of the request. These donations are not to exceed the maximum net amount of $50,000.00. The gross amount of the contribution will be included on the Donor's annual statement Form W-2, Wage and Tax Statement. There may also be a possibility of an amended W-2 being issued to the donor once the taxability concern has been addressed.

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Generous donations were received for the surviving family members. You have donated leave credits towards this benefit. Your signature below acknowledges that you understand and accept the potential taxation liability discussed above. EMPLOYEES WHO HAVE QUESTIONS OR WANT TO RESCIND THEIR ELECTION POTENTIAL TAXATION MUST IMMEDIATELY CONTACT THEIR PERSONNEL OFFICE. PRINTED NAME SIGNATURE DATE DUE TO THE