FOR C.T.A.

USE ONLY G R [ EVA N C E B LAN K FOR ATU 308 USE ONLY

Amalgamated Transit Union Local 308
O6 Y O
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411204 S. Western Ave. - Chicago, IL. 60643 - 312/782-4665 =

Freecom Through Organization R ived

= JUN 0 1 ZUz4

ATU Local 308

i: Chicago, Illinois

Date of Presentation
to Company ae Date of Presentation to Union
vate: A5* Bl- BOA / DO NOT WRITE ABOVE THIS LINE nade ALL.
name: Class Aehm Phone: Wa- TO6Z -~YoOS—
Address: Ll2bef. 3. Western fwe. Email; KA7ICCoaCA O4tUI0G- Org
City: ‘ State: Z2-zip code: OG
0678
Employment Date
Classificatio minal: ALL.
Check One:
Suspended Sick Discharged Resigned i
* Starting with the Date of Occurrence: State briefly

and plainly-What happen When and Where REMEDY.REQUESTED and if applicable, submit copies of any documents that will support your case.
-

* Begin Your Case —> Ly} TODAL Bl | be" Lola! 303 15 reglueshin

a Lf Hey PEL FA 2CsT 4:

95% time.

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Si oat 09)CCpacr_ Use other side if needed bn Date 5a

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