WASHINGTON and JURISDICTION

Most Worshipful Prince Hall Grand Lodge, F. & A.M.

WASHINGTON and JURISDICTION

Annual Report Of

Name & Number of Lodge: ______

Located at: ______

Meeting on: ______

Covering the period of: June 21, 20____ to June 20, 20____

Secretaries: Please prepare and fill in ACCURATELY…Forward original to Grand Secretary’s office and retain a copy for your files.

Payments to Grand Lodge by Quarter / Membership Accounting
QUARTER / ENDING / AMOUNT / 1st Qtr. / 2nd Qtr. / 3rd
Qtr. / 4th
Qtr.
1st QUARTER / SEPTEMBER 30: / $ / ACTIVE:
INDIGENT:
2nd QUARTER / DECEMBER 30: / $ / HONORARY:
INITIATED:
3rd QUARTER / MARCH 31: / $ / NO. DEGREES GIVEN:
DROPPED FOR N.P.D:
4th QUARTER / JUNE 20: / $ / REINSTATED:
REC’D BY PETITION:
TOTAL AMOUNT DUE: / $ / DEMITTED:
TOTAL AMOUNT PAID: / $ / SUSPENDED:
EXPELLED:
DEATHS:
REJECTED CANDIDATES:

Total Membership For Masonic Year

(______) Total Membership Ending, date: ______(______) INCREASE (______) DECREASE

(______) Total Membership Ending, date: ______(______) INCREASE (______) DECREASE

INCREASE (_____) or DECREASE (_____) FOR MASONIC YEAR

______

Worshipful Master Full Name (Print) Lodge Secretary Full Name (Print)

______

Worshipful Master Signature Lodge Secretary Signature

______

______

Worshipful Master Mailing Address Lodge or Secretary Mailing Address

______

Worshipful Master Contact Information Lodge Secretary Contact Information

Affix Lodge

Seal Here

Note: Approved by GL Jan 2013 - Supersedes all previous editions

Most Worshipful Prince Hall Grand Lodge, F. & A.M.

WASHINGTON and JURISDICTION

Annual Report Of

Name & Number of Lodge: ______

Located at: ______

Covering the period of: June 21, 20____ to June 20, 20____

No. / No. / No.
41. / 81.
42. / 82.
43. / 83.
44. / 84.
45. / 85.
46. / 86.
47. / 87.
48. / 88.
49. / 89.
50. / 90.
51. / 91.
52. / 92.
53. / 93.
54. / 94.
55. / 95.
56. / 96.
57. / 97.
58. / 98.
59. / 99.
60. / 100.
61. / 101.
62. / 102.
63. / 103.
64. / 104.
65. / 105.
66. / 106.
67. / 107.
68. / 108.
69. / 109.
70. / 110.
71. / 111.
72. / 112.
73. / 113.
74. / 114.
75. / 115.
76. / 116.
77. / 117.
78. / 118.
79. / 119.
80. / 120.

Lodge Roster Of Membership

Secretaries: Please prepare and fill in ACCURATELY…Forward original to Grand Secretary’s office and retain a copy for your files.

For GL Office Use Only

Date Received at

Grand Secretary’s Office:

______

Note: Approved by GL Jan 2013 - Supersedes all previous editions

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