Forms 1-14/Monthly Return/Page1 of 4/E-2006

Checked: ______

Checked: ______

Month of 20

RETURN

OF

Lodge No.

F\ & A\ M\

TO THE

M\W\GRAND LODGE OF

FREE & ACCEPTED MASONS

OF WASHINGTON

______

Make Original Report for Grand Secretary and

Keep Duplicate for Lodge Records

Date Received by the Grand Secretary ______


Forms 1-14/Monthly Return/Page 2 of 4/E-2006

Lodge No. / Month/Year

FORM 1 ELECTED, INITIATED, PASSED AND RAISED

MEMBER NO / LAST NAME / DATE OF BIRTH / PLACE OF BIRTH
FIRST / MIDDLE / PETITION REC / ELECTED / INITIATED / PASSED / RAISED / MM PROF
MEMBER NO / LAST NAME / DATE OF BIRTH / PLACE OF BIRTH
FIRST / MIDDLE / PETITION REC / ELECTED / INITIATED / PASSED / RAISED / MM PROF
MEMBER NO / LAST NAME / DATE OF BIRTH / PLACE OF BIRTH
FIRST / MIDDLE / PETITION REC / ELECTED / INITIATED / PASSED / RAISED / MM PROF
MEMBER NO / LAST NAME / DATE OF BIRTH / PLACE OF BIRTH
FIRST / MIDDLE / PETITION REC / ELECTED / INITIATED / PASSED / RAISED / MM PROF

FORM 2 AFFILIATED

MEMBER NO / LAST NAME / DATE OF BIRTH / PLACE OF BIRTH / PM*
FIRST / MIDDLE / PETITION REC / ELECTED / LODGE DIMITTED / NO / CITY/SATE / DATE OF DIMIT
MEMBER NO / LAST NAME / DATE OF BIRTH / PLACE OF BIRTH / PM*
FIRST / MIDDLE / PETITION REC
/ ELECTED / LODGE DIMITTED / NO / CITY/SATE / DATE OF DIMIT

FORM 3 AFFILIATED AS PLURAL MEMBER

MEMBER NO / LAST NAME / DATE OF BIRTH / PLACE OF BIRTH / PM*
FIRST / MIDDLE / PETITION REC / ELECTED / LODGE OF OTHER MEMBERSHIP / NO / CITY/SATE
MEMBER NO / LAST NAME / DATE OF BIRTH / PLACE OF BIRTH / PM*
FIRST / MIDDLE / PETITION REC / ELECTED / LODGE OF OTHER MEMBERSHIP / NO / CITY/SATE

FORM 4 REINSTATED OR RESTORED

MEMBER NO / LAST NAME / DATE OF BIRTH / PLACE OF BIRTH
FIRST / MIDDLE / PETITION REC / REINSTATED / CAUSE/MEMBERSHIP TERMINATED / DATE DROPPED / PM/PL
MEMBER NO / LAST NAME / DATE OF BIRTH / PLACE OF BIRTH
FIRST / MIDDLE / PETITION REC / REINSTATED / CAUSE/MEMBERSHIP TERMINATED / DATE DROPPED / PM/PL

*For out of jurisdiction Past Master’s Only


Forms 1-14/Monthly Return/Page 3 of 4/E-2006

Lodge No. / Month/Year

FORM 5 DEATH

MEMBER NO / LAST NAME / PM, PL EA or FC
FIRST / MIDDLE / DATE OF DEATH
MEMBER NO / LAST NAME / PM, PL EA or FC
FIRST / MIDDLE / DATE OF DEATH

FORM 6 DIMITTED

MEMBER NO / LAST NAME / PM, PL EA or FC
FIRST / MIDDLE / DATE OF DIMIT
MEMBER NO / LAST NAME / PM, PL EA or FC
FIRST / MIDDLE / DATE OF DIMIT

FORM 7 EXPELLED

MEMBER NO / LAST NAME / DATE EXPELLED
FIRST / MIDDLE / CAUSE
MEMBER NO / LAST NAME / DATE EXPELLED
FIRST / MIDDLE / CAUSE

FORM 8 SUSPENDED FOR UMC

MEMBER NO / LAST NAME / DATE SUSPENDED
FIRST / MIDDLE / CAUSE
MEMBER NO / LAST NAME / DATE SUSPENDED
FIRST / MIDDLE / CAUSE

FORM 9 REJECTED ON PETITION FOR DEGREES

MEMBER NO / LAST NAME / PLACE OF BIRTH
FIRST / MIDDLE / DATE OF BIRTH / DATE REJCTD
MEMBER NO / LAST NAME / PLACE OF BIRTH
FIRST / MIDDLE / DATE OF BIRTH / DATE REJCTD

FORM 10

REMARKS AND EXPLANATIONS IN RELATION TO WORK, MEMBERSHIP, ETC.

REPORT COURTESY DEGREES BY OR FOR OTHER LODGES, NAMES OF CANDIDATES, DATES OF DEGRESS, NAMES OF OTHER LODGES, SPEICAL DISPENSATIONS AND PURPOSE; RESTORATION TO RIGHTS OFMASONRY

o

FORM 11

DROPPED FROM ROLL FOR N.P.D.

MEMBER NO / LAST NAME
FIRST / MIDDLE
DATE DROPPED
MEMBER NO / LAST NAME
FIRST / MIDDLE
DATE DROPPED
MEMBER NO / LAST NAME
FIRST / MIDDLE
DATE DROPPED
MEMBER NO / LAST NAME
FIRST / MIDDLE
DATE DROPPED
MEMBER NO / LAST NAME
FIRST / MIDDLE
DATE DROPPED
MEMBER NO / LAST NAME
FIRST / MIDDLE
DATE DROPPED

Forms 1-14/Monthly Return/Page 4 of 4/E-2006

Lodge No. / Month/Year

FORM 12

MONTHLY RECAPITULATION OF DEGREES
Total Degrees as shown on last return (note: This will zero in January)
Degree this month EAs; FCs; MMs
Total degree to date, this year

FORM 13

MEMBERSHIP RECAPITULATION FOR MONTH
MEMBERS beginning of month, from last return
GAIN
By being Raised
By signing By-Laws
(Raised prior to June 2000)
By Affiliation
By Affiliation for Plural Membership
By Reinstatement
Total gain for month
Total including gain
LOSS
By death
By dimission
By expulsion
By suspension
By dropped for NPD
Total loss for month
MEMBERS end of month

FORM 14

I hereby certify that the foregoing return is correct and a true statement of the membership changes of this lodge for this month.

______

(LODGE SEAL) Secretary-

Key to Abbreviations
P.M. Past Master
PL. Plural Member
E.A. Entered Apprentice
F.C. Fellowcraft
M.M. Master Mason