4. AFFILIATION OR ORGANIZATION
NAME
|
8. MAILING
ADDRESS (in care of) NAME AND TITLE OF PERSON |
| 5. DESIGNATION (Local, Lodge, |
6.
DESIGNATION NUMBER |
NUMBER AND
STREET
|
7. UNIT NAME (if any
|
BUILDING AND ROOM NUMBER (if
any
|
9. Are your organization's
records kept at its
mailing address? (If "No, " provide address in Item
75.) |
Yes No |
|
| DURING THE REPORTING PERIOD DID YOUR
ORGANIZATION: |
Yes No |
18. How many members did your
organization have at the end of the reporting period? |
10. Have a Subsidiary
organization" as defined in Section X of the instructions? |
|
19. What is the date of
your organization's next regular
election of officers?Month Year 0699 |
| 11. Create or participate
in the administration of a trust or other fund or organization, as defined
in the instructions, which provides benefits for members or their
beneficiaries? |
|
20. What is the maximum amount
recoverable under
your organization's fidelity bond for a loss caused by
any officer or employee of your organization?
$ |
| 12. Have a political
action committee (PAC) fund? |
|
21. What are your
organization's rates of dues and fees?
(Enter a minimum and
maximum if more than one rate applies for any line.) |
13. Acquire or dispose of
any goods or property in any manner other than by purchase or sale?
|
|
|
| 14. Have an audit or review of its books and records by an
outside accountant or by a parent body auditor/representative?
|
|
| 15. Discover any loss or shortage of funds or other
property? (Answer slyest even if there has been repayment or
recovery) |
|
| 16. Have any officer who was paid $10,000 or more by your
organization and also received $10,000 or more as an officer or
employee of another labor organization or of an employee benefit
plan? |
|
17. Liquidate or reduce any liabilities without
disbursement of cash? |
|
22. During the
reporting period, did your organization have
any changes in its
constitution and bylaws (other than rates
of dues and fees) or in
practices/procedures listed in the
instructions? (If the constitution
and bylaws have changed,
attach two new dated copies. If
practices/procedures have
changed, see the instructions.)
|
(If the answer to any
of the above questions is Yes, " provide details in Item 7 5 as explained
in the
instructions for each item.) |
|
23. Were any of your organization's
assets pledged as
security or encumbered in any other way at the end
of
the reporting period?
|
|
24. Did your
organization have any contingent liabilities
at the end of the reporting
period?
(If the answer to Item 23 or 24 is "Yes, "
provide details
in Item 7 5.)
|
|
Each of the undersigned, duly
authorized officers of the above labor organization, declares, under the
applicable penalties of law,
that all of the information submitted in this
report (including the information contained in any accompanying documents)
has
been examined by the signatory and is, to the best of the
undersigned's knowledge and belief, true, correct, and complete.
(See
Section VI on penalties in the instructions.)
|
|
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| Form LM-2 (Revised 1994) |
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