The following shall be considered a legally binding amendment to the agreement made between ____________ and ____________, dated ______________:
You are hereby notified that the sum of __________________ dollars will be deducted monthly from your salary to be paid into and constitute a part of the _______________ (Teachers Retirement Fund) of _________________ (state). This sum is computed as _______ percent (__%) o f your annual salary as authorized by the_____________ law.