Membership Report and Per Capita Tax Payment

Membership Report and Per Capita Tax Payment

First half tax due NOVEMBER 1st - Last half tax due MAY 1st, Each Year
Completed By
Email
example@example.com
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Per Capita For
Year
State Rate
Half Year - $10 / Full Year - $20
National Rate
Half Year - $7.25 / Full Year - $14.50
Admin Fee Due
Payable with First Half Payment Only
For the Year Of
State
Lodge Name
Lodge #
Total Number of Members on National Membership Roster
Current Membership in Ortu3
Total Loss of Membership
New Members
Transfers In
Reinstated
Total Gain of Membership
TOTAL NUMBER OF MEMBERS PER CAPITA TAX IS DUE ON
IMPORTANT

Be sure to submit any losses, gains, and reinstatements in Ortu3 for approval. For transfers between lodges, contact State Secretary Miller.
STATE LODGE PER CAPITA TAX
Half Year: $ 10.00 Per Member

Full Year: $ 20.00 Per Member
State Total
NATIONAL FOP PER CAPITA TAX
Half Year: $ 7.25 Per Member

Full Year: $ 14.50 Per Member

Administrative Fee @ $ 25.00

(Include Admin Fee w/ First Half Payment Only)
National Total
Balance/Credit

(From National FOP Membership Report)
Balance/Credit
Total Per Capita Payment
I hereby authorize the Wisconsin State Lodge, Fraternal Order of Police, to initiate an ACH debit from the bank account on file for the payment of State and National per capita and associated fees for the amounts indicated above.
Local Lodge Secretary
State Lodge Secretary
Should be Empty: