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4. AFFILIATION OR
ORGANIZATION NAME
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8. MAILING
ADDRESS (in care of) NAME AND TITLE OF PERSON |
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5. DESIGNATION
(Local, Lodge, etc.)
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6.
DESIGNATION NUMBER |
NUMBER AND
STREET
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7. UNIT NAME (if
any
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BUILDING AND ROOM
NUMBER (if any
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9. Are your
organization's records kept at its mailing address ?(If "No, " provide
address in Item 75.) |
Yes No
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CITY
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STATE
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ZIPCODE
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DURING THE REPORTING
PERIOD DID YOUR ORGANIZATION: |
Yes No |
18. How many members
did your organization have at the end of the
reporting period? |
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10. Have a Subsidiary
organization" as defined in Section X of the instructions?
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19. What is the date
of your organization's next regular election of officers? |
To be determined Council is in
Trusteeship Month Year |
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11. Create or
participate in the administration of a trust or other fund or
organization, as defined in the instructions, which provides benefits
for members or their beneficiaries? |
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20. What is the
maximum amount recoverable under your organization's fidelity bond for a
loss caused by any officer or employee of your organization? $ |
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12. Have a political
action committee (PAC)fund? |
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21. What are your
organization's rates of dues and fees? (Enter a minimum and
maximum if more than one rate applies for any line.) |
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13. Acquire or dispose
of any goods or property in any manner other than by purchase or
sale? |
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Rates of Dues and Fees |
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14. Have an audit or
review of its books and records by an outside accountant or by a
parent body auditor/representative? |
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(a) Regular Dues/Fees |
$ |
per |
(month, year, etc )
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15. Discover any loss
or shortage of funds or other property?(Answer slyest even if there
has been repayment or recovery) |
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(b) Initiation Fees
(c) Transfer Fees
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$ $ |
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16. Have any officer
who was paid $10,000 or more by your organization and also received
$10,000 or more as an officer or employee of another labor
organization or of an employee benefit plan? |
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(d) Work Permits |
$ |
per |
(month, year, etc )
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1 7. Liquidate or
reduce any liabilities without disbursement of cash? |
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22. During the
reporting period, did your organization have any changes in its
constitution and bylaws (other than rates of dues and fees) or in
practices/procedures listed in the instructions?(If the constitution
and bylaws have changed, attach two new dated copies. If
practices/procedures have changed, see the instructions.)
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Yes
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No
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(If the answer to any of the above questions is
Yes, " provide details in Item 7 5 as explained in the instructions for
each item.) |
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23. Were any of your
organization's assets pledged as security or encumbered in any other way
at the end of the reporting period? |
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24. Did your
organization have any contingent liabilities at the end of the reporting
period? (If the answer to Item 23 or 24 is "Yes, " provide
details in Item 7 5.) |
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Each of the undersigned, duly authorized
officers of the above labor organization, declares, under the applicable
penalties of law, that all of the information submitted in this report
(including the information contained in any accompanying documents) has
been examined by the signatory and is, to the best of the undersigned's
knowledge and belief, true, correct, and complete. (See Section VI on
penalties in the instructions.) |
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76. SIGNEDPRESIDENT (If other tit/e,
see instructions)
Date Telephone Number |
77. SIGNEDSecretary-TREASURER (If other
tit/e,see instructions)
Date Telephone Number |
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Form LM-2 (Revised 1994) |
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Page 1 of 6 |
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