MWPHGL of California
REPORT DUE: MAY 1st—AUGUST 1st—NOVEMBER 1st—FEBRUARY 1st
QUARTERLY REPORT
Month   
 
Lodge Name:     Lodge No:   City
Secretary email address:  
SUMMARY
STATISTICAL:
Members on LAST REPORT
PER CAPITA TAX CALCULATION WORKSHEET
Members for Current Period @
$3.75
Members Raised for Probation Advance @
$5.00
Members Healed for Probation Advance @
$5.00
Members Affiliation for Probation Advance @
$5.00
Members Reinstated for Probation Advance @
$5.00
Other Monies due Relief Department
TOTAL AMOUNT DUE RELIEF DEPARTMENT
FINANCIAL (General Department)
Members for Current Period @
$8.75
Members Raised @
$7.50
Members Healed @
$65.00
Members Affiliated @
$12.50
Members Reinstated @
$12.50
Members Entered @
$65.00
Associate Members (May Only) @
$30.00
Members G.M. Conference & NAACP (Feb Only) @
$1.00
Members Civic Affairs (Feb Only) @
$1.00
Members Cards (Feb Only) @
$0.20
Late FEE @
$50.00
TOTAL AMOUNT DUE GENERAL
Number of Associate Members
Number of 50 Year Members
INCREASES:
By (A) Raised
By (B) Healed
By (C) Affiliated
By (D) Reinstated
Total of LAST Report and Increase
 
DECREASES:
By (E) Suspended N.P.D
By (F) Deceased
By (G) Demitted
By (H) As Stated
Total Members on this report
 
Less 50 Year/GM/MWPGMs
 
Payable Members for Current Period
 
CERTIFICATION THAT THIS REPORT IS CORRECT
Lodge Name:   Lodge No:       
   
Worshipful Master
       
Secretary
DATES ARE IMPORTANT
50 YEAR MEMBERS
Name of 50 Year Member
DOB
Address
Date Raised

A. This category "A" includes ONLY those Raised                               RAISED
Name of Raised
DOB
Address
Date Raised

B. This category includes ONLY those                                                       HEALED
Name of Heald
DOB
Address
Date Heald


C. This category includes Affiliations among Lodges AFFILIATED
of California and those of foreign Jurisdictions
Name / Address of Affiliated
DOB
Jurisdiction and Lodge No.
Date of Affiliation

Name:       
Address:  

Name:       
Address:   


 
D. This category includes ONLY those Reinstated REINSTATED
Name of Reinstated
DOB
Address
Date Reinstated
 
 
 
 
 
SUSPENDED
DECEASED
E. Name of Suspended
Date Suspended
 F. Name of Deceased
Date of Death
DEMITED
G. Name of Demitted
Date Demitted
EXPELLED/WITHDREW & ETC
H. Name of Expelled. Etc.
Date

ENTERED ONLY
Name of Entered
Date Entered
Where Born (City and State)
Date of Birth

ADDRESS CHANGES
Name
Old Address
New Address