Grand Commandery of Knights Templar of the State of Illinois

Grand Commandery of Knights Templar of the State of Illinois

Commandery No. Stationed At______

1.) recapitulation

1. Number of MEMBERS ON (01/01/2016) ------

2. Number KNIGHTED year ending (12/31/2016) ------

3. Number AFFILIATED, ------

4. Number REINSTATED------_

5. GAIN for (Line 2+3+4=)------

DEDUCTIONS 6. Number DEMITTED or TRANSFERRED----

7. Number SUSPENDED------

8. Number DECEASED------

9. Number EXPELLED------

10. LOSS FOR YEAR (Line 6+7+8+9=)------

11. Present ACTIVE MEMBERSHIP 12/31/2016) Line 1 add 5 minus Line 10)------

“PER CAPITA”

12. Present ACTIVE MEMBERSHIP (12/31/2016) Line 11)------

ALLOWABLE DEDUCTIONS

13. Number KNIGHTED during the year (Line 2)------

14. Number AFFILIATED during the year (Line 3)------

15. FIFTY YEAR MEMBERS ______

16. TOTAL DEDUCTIONS (Line13+14+15=)------

ADDITIONS

17. Number DEMITTED or TRANSFERRED (Line 6) Note Per Capita must be paid on all

Members Demitting or Transferring during the year.------

18. Total Number PER CAPITA must be PAID ON (Line 12 less line 16 plus 17)------FINANCIAL STATEMENT+

19. Per Capita on -- members (Line 18 X’s $10.00)------

20. Fees on------members KNIGHTED (Line 2 X’s $10.00 each)------

21. EYE FOUNDATION ASSESSMENT on Members(Line 11)

DEDUCT Life Sponsors

Total Assessment = X’s $1.00------

22. GRAND ENCAMPMENT PER CAPITA DUES (Line 11) ______X’s $9.00------

23. TOTAL DUE -GRAND COMMANDERY (Lines 19+20+21+22+23=)------$ ______

NOTE: Make checks payable to the Grand Commandery of Illinois TOTAL

24. Insurance Payment Due if Applicable (Make Check for Insurance separate).

Recorder

PER-CAPITA MUST BE PAID BEFORE JUNE 30, 2016 TO AVOID A $50.00 LATE CHARGE AND

LOSING YOUR COMMANDERY BALLOTS AT THE GRAND CONCLAVE. YOU MAY PAY YOUR PER-CAPITA BEFORE IT IS DUE, WHICH THE RECORDERS OFFICE PREFERS. DO NOT HAND IT TO THE GRAND RECORDER AT THE CONCLAVEAS IT MIGHT GET LOST OR MISS PLACED