FOP Active PC Tax Form

FRATERNAL ORDER OF POLICE
Membership Report and PerCapita Tax Payment

First half tax due NOVEMBER 1st - Last half tax due MAY 1st, Each Year

FOR THE YEAR OF First Half 2025
Lodge Name
Lodge Number
Total Number of Members on National Membership Roster
Total Loss of Membership
New Members
Transfers In
Reinstated
Total Gain of Membership
TOTAL NUMBER OF MEMBERS PER CAPITA TAX IS DUE ON
First Half
National $5.75
State Lodge $12.50

Full Year
National $11.50
State Lodge $25.00

One Time $25 Fee Per Lodge (National Admin Fee)
Full Year or First Half Only
State Full Year or First Half Only
Total State FOP
Total National FOP
IMPORTANT: MUST BE SIGNED BY STATE SECRETARY
Lodge Secretary Signature

Powered by Jotform SignClear
Should be Empty:

FRATERNAL ORDER OF POLICE