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
Date

MonthDayYear
Date
For the Year Of
Lodge Name
Lodge #
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
STATE LODGE PER CAPITA TAX
Last Half Year: $ 10.00 Per Member

Full Year: $ 20.00 Per Member
Total
NATIONAL FOP PER CAPITA TAX
Last Half Year: $ 5.75 Per Member

Full Year: $ 11.50 Per Member

Administrative Fee @ $ 25.00

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

(From National FOP Membership Report)
Total
IMPORTANT

If adding new members with this report, make sure to complete the Online Gains Form.
How will you be making payment?
If I choose to make payment electronically through ACH, 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: