Communications Workers of America

                                                    Local 2106

                                        Statement of Occurrence

 Pursuant to Article 12, Section B, this is to notify the Company of the Union's intent to

 formally present a grievance in behalf of:

NAME/S OF GRIEVANT/S:

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ISSUE INVOLVED:

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DATE OF OCCURRENCE: ___________________   TODAY'S DATE:______________

CONTRACT ARTICLES CITED (If Any):

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REMEDY REQUESTED:

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STEWARD'S NAME: _____________________________________________________

                                    (Printed)                                                      (Signed)