Region District No. Date Report Completed

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ANNUAL REPORT 2014

MOST WORSHIPFUL PRINCE HALL GRAND LODGE

OF FREE AND ACCEPTED MASONS OF NORTH CAROLINA

AND JURISDICTION, INC.

P. O. Box 1507, Durham, NC, 27702-1507

ANNUAL REPORT FOR THE MASONIC YEAR ENDING JUNE 30, 2014 SHOULD BE RECEIVED BY GRAND LODGE NO LATER THAN JULY 31, 2014

(Please type or print legible)

Lodge Information:

Lodge Name: Lodge No.________

Region District No. Date Report Completed_____________

Incoming Worshipful Master Name: _____________________________________________________

Address: ______________________________________City___________________NC Zip: _______-____ Home Phone: ( ) – _______________________ Cell Phone: ( ) – ________________________ E-Mail ____________________________________

Send ALL Correspondence and Communications To:

Title:______________________ Name:_____________________________________________________ Address:____________________________________ City ___________________NC Zip:_______-____ Home Phone: ( ) – _______________________ Cell Phone: ( ) – ________________________ E-Mail:____________________________________

Physical Street Address, City, State, Zip Code of Masonic Temple:

______________________________________________________________________________________

Mailing Address, City, State, Zip Code of Masonic Temple:

______________________________________________________________________________________ Day and Time of Meetings:

______________________________________________________________________________________

REQUIRED IRS INFORMATION:

IRS GEN (Group Exempt No.) ____ Local Lodge’s IRS Tax ID:__________________________________

TOTAL RECEIPTS FOR MASONIC YEAR ENDING JUNE 30, 2014 $______________________________

►LODGE SEAL AND CERTIFICATION OF REPORT:

(SEAL)

W.M. ______________________________________ Bonded ( ) Yes ( ) No Secretary______________________________________ Bonded ( ) Yes ( ) No Treasurer______________________________________ Bonded ( ) Yes ( ) No

FOR GRAND LODGE OFFICE USE ONLY

DATE AMOUNT INITIALS Annual Report Received By Grand Lodge **********

Payments Received

Number of Cards **********

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Lodge Name __________ Lodge No.

Elected and Appointed Returns:

Title Name Primary Telephone Email

W.M. S.W. J.W. S.D. J.D. S.S. J.S. Marshal Chaplain Secretary Asst Secy Treasurer Tiler Other Other

Roster of Active Past Masters:

Names, Dates and Specify Where If Different Lodge

Members Not Eligible For Benevolence:

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Lodge Name Lodge No.______

Membership Summary:

**Note: Reference ALL Supplemental Reports Sent To Grand Lodge From

July 1, 2013 through June 30, 2014

1.

Number of members

on roll

June 30, 2013

(This number should be from previous year’s report) _____

THROUGH

Line 10 –

SUBTOTAL 2

______

12.

SUBTRACT Line 11

FROM

Line 7 –

MEMBERSHIP TOTAL

on

June 30, 2014

_______

13.

Number of members

NOT ELIGIBLE FOR BENEVOLENCE

on

June 30, 2014

_______

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Lodge Name Lodge No.______

Summary of Payments:

►

Grand Lodge

Dues for July 1, 2013 through June 30, 2014

This Column For Grand Lodge Use Only

1. Grand Lodge Benevolent Dues ($12.00 x Number Benevolent Members) $ $ 2. Grand Lodge Dues ($18.00 x Total Membership) $ $

3. TOTAL $ $

4. Previous Balance ON Local Lodge’s Grand Lodge Account $ $ 5. Total Benevolence Due (From Line 1 – separate check) $ $ 6. Total Grand Lodge Taxes Dues (From Line 2) $ $ 7. Late Fee Penalty $100.00 if Annual Return is submitted after July 31 $ $ 8. ADD Line 4, Line6 and Line 7 – GRAND TOTAL GRAND LODGE TAX

(separate check)

$ $

9. Total Amount Submitted $ $

10. BALANCE DUE: GRAND LODGE CREDIT $ $

INSTRUCTIONS FOR CALCULATING PAYMENT USING THE MEMBERSHIP CALCULATION KEY Summary of Payments:

Line 1: In order to calculate the total amount of Grand Lodge Benevolent Dues to send in with this report you will need Appendix 1. Read the charts down then across. For example on this chart you have 4 benevolent members on roll as of June 30, 2014. The amount you would enter into Line 1 of Page 4 is $48.00.

# Of Members X$12.00 # Of Members X $12.00 1 $ 12.00 6 $ 72.00 2 $ 24.00 7 $ 84.00 3 $ 36.00 8 $ 96.00 4 $ 48.00 9 $ 108.00 5 $ 60.00 10 $ 120.00

Line 2: In order to calculate the total amount of Grand Lodge Dues to send in with this report you will need Appendix 2. Read the charts down then across. For example on this chart you have 9 members on roll as of June 30, 2014. The amount you would enter into Line 2 of Page 4 is $162.00.

# Of Members X$18.00 # Of Members X $18.00 1 $ 18.00 6 $ 108.00 2 $ 36.00 7 $ 126.00 3 $ 54.00 8 $ 144.00 4 $ 72.00 9 $ 162.00 5 $ 90.00 10 $ 180.00

Payments for Prorated Dues and Miscellaneous Fees July 1, 2013 through June 30, 2014

**Note: ALL MEMBERS RAISED, REINSTATED, DEMITTED IN AND

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Lodge Name Lodge No.______

Register of Names and Dates of Incoming members:

Raised/Healed

Last Name First Name Date of Birth **Date Raised/Healed ***Code

** If date raised is left blank you will be charged for the entire year. ***Code = R for Raised; H for Healed

Reinstated

Last Name First Name **Date Reinstated Date Dropped DOB

** If date reinstated is left blank you will be charged for the entire year.

Demit In

Last Name First Name **Date Demitted Date Raised DOB

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Lodge Name Lodge No.______

Register of Names and Dates of Outgoing members:

Deceased

Last Name First Name Date Deceased

Demit Out

Last Name First Name Date Demitted Out

Dropped / Suspended Members

Last Name First Name Date Dropped **Code

**Code = D - Dropped for Non Payment of Dues; S - Other than Non Payment of Dues

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