ANNUAL REPORT -

Acacia Lodge #20, Dover NJ

Free & Accepted Masons

ANNUAL REPORT
YEAR ENDING DECEMBER 31, 20__ Check # ____________________

____________________________ . ____________Amounts ___________________

CERTIFICATIONS
Date Rec’d. _________________

I do hereby certify that this Report for the year ending December 31st 20__ to
be correct, and the Per Capita Tax and Foundation Annual Assessment is as follows:

0
0.00
1. PER CAPITA …………………… $9.50 X _________ members = $ ___________________________________
I.LINE O MAKE CHECK PAYABLE TO Acacia Lodge #20, Dover NJ

0
0.00
2. ANNUAL ASSESSMENT………..$3.00 X _________ members = $ ___________________________________
V. LINE 7 MAKE CHECK PAYABLE TO Acacia Lodge #20, Dover NJ FOUNDATION
(signature) Grand Tall Cedar for closing year 20_
(signature) Scribe for closing year 20__

I. MEMBERSHIP
A. Total Membership as reported on last Annual Report
_________________
B. Initiated _________________
G. Demitted _________________
C. At-Sight _________________
H. Suspended (NPD) _________________
D. Affiliated _________________
I. Deceased _________________
E. Reinstated _________________
J. Suspended/Expelled _________________
0
0

F. Total Gains _________________
K. Total Losses _________________
0

L. Membership total including Life & At-sight (‘A’ plus ‘F’ minus ‘K’)
_________________
M. Number of “At-sight” members on Forest roster
_____________
N. Number of members residing in Masonic Homes
_____________
0

O. Number of members subject to Per Capita Tax (‘L’ minus ‘M’ and ’N’)
_____________
II. TREASURER’S REPORT: Name of Bank:
___________________________ Acct. No. ____________
Balance on hand, December 31, 20__ as per last report
(1) $ ________________
Total Receipts (2) $ ________________
Total Expenditures (3) $ ________________

0.00
Balance on hand, December 31, 20__ (1 plus 2 minus 3)
$ ________________

Treasurer’s Signature ____________________________________

III. TRUSTEES’ REPORT:
Name of Bank: ___________________________ Acct. No. _____________
Balance on hand, December 31, 20__ as per last report (1) $ ________________
Total Receipts (2) $ ________________
Total Expenditures (3) $ ________________
Balance on hand, December 31, 20__…………(1 plus 2 minus 3)
________________

0.00
Trustee’s Signature ____________________________________

IV. Acacia Lodge #20, Dover NJ MEMBERSHIP FUND: Name of Bank: ____________________ Acct. No. ____________
A. Amount in Acacia Lodge #20, Dover NJ Life Membership Fund $ _____________________
B. Officer in charge of Life membership Fund ___________________Treasurer __________________Trustee
V. Acacia Lodge #20, Dover NJ FOUNDATION – ANNUAL FINANCIAL REPORT
A. LIFE MEMBER REPORT: 1. TCF Life Members, previous year December 31, 20__ _________
2. TCF Life Members purchased current year _________
3. TCF Life Member losses current year
_________
0

4. Total TCF Life Members on Forest Records _________
(line ‘1’ plus line ‘2’, minus line ‘3’ equals line ‘4’)

0

B. ASSESSMENT: 5. Membership as of December 31, 20__ (Section I/line O) _________
0

6. Minus TCF living Life Members (line 4 above) _________
0

7. Total (line’5’ minus line ‘6’)
_________
0.00
8. Assessment due $3.00 X line ‘7’ equals
$________
This Foundation report completed by: ________________________ Forest No. ________ Date ____________