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Reciprocity Forms - Transfer of Benefits


Find the Local for the area that you worked in below, click on the link, print, complete and mail to the address at the top of each form.  If you are not sure what the

Local number is for the jurisdiction you worked in, the following link found on the UBC Millwrights page is helpful to determine that.


External link opens in new tab or windowFIND A UBC MILLWRIGHT - This site brings up the United States map.  Click on the state to find out the Local and then find the forms below.


TRANSFER FORMS for Local #1076 Members Working Outside of our Jurisdiction


  • External link opens in new tab or windowTransfer Forms - Blank

  • External link opens in new tab or windowLocal #102 - Northern California (Verified 10/02/24)

  • External link opens in new tab or windowLocal #174 (Carpenters) - Illinois  Covering Will County (Verified & Updated 11/06/20)

  • External link opens in new tab or windowLocal #216 - Arkansas / Oklahoma (Verified & Updated 07/19/23)

  • External link opens in new tab or windowLocal #219 - (Previously #1548) - Baltimore, MD & Washington DC  (Updated 09/04/24)

  • External link opens in new tab or windowLocal #219 - (Previously #1906) - Philadelphia, Pennsylvania (Verified & Updated 09/01/17)

  • External link opens in new tab or windowLocal #443 - (Previously #1024) - Western Maryland Covering the counties of Allegany, Garrett and Washington in Maryland and Berkeley, Grant, Hampshire, Hardy, Jefferson, Mineral, Morgan, and Pendleton in West Virginia. (Verified 02/08/21)

  • External link opens in new tab or windowLocal #443 - (Previously #1402) - Virginia (Verified & Updated 09/01/17)

  • External link opens in new tab or windowLocal #443 - (Previously #1755) - West Virginia   Covering the counties of Barbour, Boone, Braxton, Brooke, Cabell, Calhoun, Clay, Doddridge, Fayette, Gilmer, Greenbrier, Hancock, Harrison, Jackson, Kanawha, Lewis, Lincoln, Logan, Marion, Marshall, Mason, McDowell, Mercer, Mingo, Monongalia, Monroe, Nicholas, Ohio, Pleasants, Pocahontas, Preston, Putnam, Raleigh, Randolph, Ritchie, Roane, Summers, Taylor, Tucker, Tyler, Upshur, Wayne, Webster, Wetzel,  Wirt, Wood and Wyoming  (Verified & Updated 08/25/22) 

  • External link opens in new tab or windowLocal #443 - (Previously #2235 & Local #2237) - Pennsylvania  Covering the counties of Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Centre, Clarion, Clearfield, Clinton, Crawford, Elk, Erie, Fayette, Forest, Fulton, Greene, Huntington, Indiana, Jefferson, Lawrence, McKean, Mercer, Mifflin, Potter, Somerset, Venango, Warren, Washington and Westmoreland in Pennsylvania. 

  • External link opens in new tab or windowLocal #548 - Northwest Wisconsin & Southern Minnesota (Verified 05/23/22)

  • External link opens in new tab or windowLocal #715 - New Jersey (Verified & Updated 05/13/24)

  • External link opens in new tab or windowLocal #716 - Eastern Missouri (including St Louis) & Southern Illinois (Verified 06/08/21)
  • External link opens in new tab or windowLocal #729 - Louisiana (Verified & Updated 04/19/22)

  • External link opens in new tab or windowLocal #740 - New York  (Verified & Updated 08/30/18)
  • External link opens in new tab or windowLocal #1056 - Wisconsin

  • External link opens in new tab or windowLocal #1090 - Central Ohio (Columbus) covering Delaware, Fairfield, Franklin, Guernsey, Licking, Madison, Marion, Morgan, Muskingham, Noble, Perry, Pickaway and Union Counties in Ohio.
  • External link opens in new tab or windowLocal #1090 - Northeast Ohio (Akron/Canton, Cleveland, Lorain, Youngstown, Steubenville), covering Ashland, Ashtabula, Belmont, Carroll, Columbiana, Coschocton, Cuyahoga, Erie Geauga, Harrison, Holmes, Huron, Jefferson, Knox, Lake, Lorain, Mahoning, Medina, Monroe, Morrow, Portage, Richland, Stark, Summit, Trumbull, Tuscarawas, Washington and Wayne Counties in Ohio
  • External link opens in new tab or windowLocal #1090 - Northwest Ohio (Toledo/Lima) covering Allen, Auglaize, Crawford, Defiance, Fulton, Hancock, Hardin, Henry, Lucas, Mercer, Ottawa, Paulding, Putnam, Sandusky, Seneca, Van Wert, Williams, Wood and Wyandot Counties in Ohio
  • External link opens in new tab or windowLocal #1090 - South Central Ohio (Ironton) covering Adams, Fayette, Galia, Highland, Hocking, Jackson, Lawrence, Meigs, Pike, Ross, Scioto and Vinton Counties in Ohio
  • External link opens in new tab or windowLocal #1090 - Southwest Ohio (Cincinnati/Dayton) covering Brown, Butler, Champaign, Clark, Clermont, Darke, Greene, Hamilton, Logan, Miami, Montgomery, Preble, Shelby and Warren Counties in Ohio

  • External link opens in new tab or windowLocal #1091 - North Dakota (Verified & Updated 03/27/25)

  • External link opens in new tab or windowLocal #1000 & Local #2411 - Florida

  • External link opens in new tab or windowLocal #1102 - Michigan covering the State of Michigan.  See Local #1510 for Upper Peninsula of Michigan.  (Verified & Updated 06/09/22)
  • External link opens in new tab or windowLocal #1176 - North Dakota (Verified & Updated 05/11/21)

  • External link opens in new tab or windowLocal #1192 - Central Alabama covering the counties of Autauga, Bibb, Blount, Bullock, Calhoun, Cherokee, Chilton, Clay, Cleburne, Coosa, Cullman, Dallas, Elmore, Etowah, Fayette, Greene, Hale, Jefferson, Lamar, Lowndes, Macon, Marshall, Montgomery, Perry, Pickens, Pike, Randolph, Shelby, St. Clair, Sumter, Talladega, Tallapoosa, Tuscaloosa and Walker (Verified & Updated 04/18/19)

  • External link opens in new tab or windowLocal #1192 - North Alabama / Mississippi / Tennessee covering the following Counties in Alabama: Parts of Jackson and Marshall. Colbert, Fayette, Franklin, Lamar, Lauderdale, Lawrence, Limestone, Madison, Marion, Morgan and Winston; the following Counties in Mississippi: Alcorn, Benton  , Calhoun, Chickasaw, Choctaw, Clay, Itawamba, Lee, Lowndes, Monroe, Oktibbeha, Pontotoc, Prentiss, Tippah, Tishomingo, Union and Webster; the following Counties in Tennessee: parts of Franklin, Giles, Hardeman, Hardin, Lawrence, Lincoln, McNairy and Wayne (Verified & Updated 12/16/21)

  • External link opens in new tab or windowLocal #1192 - Gulf Coast - Alabama / Florida / Mississippi covering the following Counties in Alabama: Baldwin, Choctaw, Clarke, Conecuh, Covington, Escambia, Marengo, Mobile, Monroe, Washington and Wilcox; the following Counties in Florida:  Bay, Calhoun, Escambia, Franklin, Gulf,Holmes, Jackson, Liberty, Okaloosa, Santa Rosa, Walton and Washington; the following Counties in Mississippi:  Adams, Amite, Covington, Forrest, Franklin, George, Greene, Hancock, Harrison, Jackson, Jefferson Davis, Jones, Lamar, Lawrence, Lincoln, Marion, Pearl River, Perry, Pike, Stone, Wathall, Wayne and Wilkinson (Verified & Updated 04/18/19)

  • External link opens in new tab or windowLocal #1192 - Central Mississippi / Louisiana covering the following Counties in Mississipi: Attala, Carroll, Claiborne, Clarke, Copiah, Grenada, Hinds, Holmes, Humphreys, Issaquena, Jasper, Jefferson, Kemper, Lauderdale, Leake, Leflore, Madison, Montgomery, Neshoba, Newton, Noxubee, Rankin, Scott, Sharkey, Simpson, Smith, Sunflower, Winston, Warren, Washington and Yazoo; and the following Counties in Louisiana:  Catahoula, Concordia and Madison (Verified & Updated 10/05/21)

  • External link opens in new tab or windowLocal #1121 - Maine, Massachusetts, New Hampshire, Rhode Island & Vermont (Verified & Updated 01/24/18)

  • External link opens in new tab or windowLocal #1121 - Connecticut (Verified & Updated 01/24/18)

  • External link opens in new tab or windowLocal #1163 - New York
  • External link opens in new tab or windowLocal #1263 - Georgia / Carolinas

  • External link opens in new tab or windowLocal #1348 - Northern Minnesota
  • External link opens in new tab or windowLocal #1421 - Texas (Verified & Updated 05/17/24)

  • External link opens in new tab or windowLocal #1463 - Nebraska & Western Iowa (Verified & Updated 06/27/24)
  • External link opens in new tab or windowLocal #1510 - Michigan covering the Upper Peninsula of Michigan.  See Local #1102 for the State of Michigan.  (Verified & Updated 06/09/22)

  • External link opens in new tab or windowLocal #1529 - Kansas

  • External link opens in new tab or windowLocal #1554 - Tennessee

  • External link opens in new tab or windowLocal #1607 - California (Verified & Updated 10/05/21)

  • External link opens in new tab or windowLocal #1693 - Northeast Illinois (Chicago) covering the Counties of Cook, Lake and Dupage (Verified & Updated 06/04/21)
  • External link opens in new tab or windowLocal #1693 - Central Illinois  (Verified & Updated 06/13/23)

  • External link opens in new tab or windowLocal #2158 - Illinois - Zone 3 covering the counties of Jo Daviess, Stephenson, Winnebago, Boone & Ogle (Verified & Updated 11/03/17)
  • External link opens in new tab or windowLocal #2158 - Northwest Illinois - Zone  5 (Rockford) - Eastern Iowa (Verified & Updated 06/08/21)

  • External link opens in new tab or windowLocal #2232 - Texas (Verified & Updated 02/15/23)

  • External link opens in new tab or windowLocal #2337 - Wisconsin (Milwaukee) (Verified & Updated 12/16/21)




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  • External link opens in new tab or window317-807-5715
  • External link opens in new tab or window771 Greenwood Springs Dr , Greenwood, IN, 46143, US
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