MOST WORSHIPFUL PRINCE HALL GRAND LODGE

STATE OF SOUTH CAROLINA

ANNUAL REPORT FOR 2013

(USE MICROSOFT EXCEL 97 OR LATER, PRINT, MAIL TO THE R.W.GRAND SECRETARY)
Lodge
Lodge #
Address:
City:
State:
To The Grand Secretary: McDuffie Bartelle
Find herewith the total amount opposite the name of each member here below:
TOTAL

Zip Code:

Dues:
Charity:
Building Fund:
Life Membership:
NAACP:
Relief Fund:

0
0
0
0
0
0

For the TERM Beginning December 1, 2012 and Ending November 30, 2013
ENTER NAMES, ALPHABETICALLY (USE MICROSOFT EXCEL 97 OR LATER.
The following beneficial members should include the amount for Grand Lodge Dues, Charity Tax, Building
Funds, Life Member, NAACP, Relief Fund, Date of Birth, Date Raised and Donee.
NOTE: (1) FOR LIFE MEMBERS, TYPE "YES" IN THE LIFE MEMBER COLUMN.
(2) PUT AN ASTERICK (*) AFTER EACH PAST MATER.
***If the Annual Report IS NOT turned in by November 15, 2013. Please include the $50.00 Processing Fee***
Elected Officers
Grand
Charity
Building Life Member NAACP
Relief
DOB
AGE
Raised
Lodge
Tax
Funds
$4.00
$1.00
Fund
$14.00
$7.00
$5.00
$1.00
1

WM

SW

JW

TREA

SEC

YRS

2013

2013

2013

2013

2013

2013

2013

2013

2013

2013

Total:
Lodge Members

6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45

Life
Member
(YES)

$0.00

$0.00

$0.00

$0.00

$0.00

Grand
Lodge
$14.00

Charity
Tax
$7.00

Building
Funds
$5.00

Life Member
$4.00

NAACP
$1.00

Relief
Fund
$1.00

DOB

AGE

2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013

Raised

YRS

2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013

46
47

2013
2013

2013
2013

48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89

2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013

2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013

90
91
92

2013
2013
2013

2013
2013
2013

93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132

2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013

2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013

133
134
135
136
137
138
139
140
141
142
143
144
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180

2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013

2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013

Total:

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

No.

Admitted by Demit

From
Lodge

In State Out of State

$29.00
$35.00

DOB

Age

Raised

2013
2013
2013
2013
2013
2013
2013
2013
2013
2013

1
2
3
4
5
6
7
8
9
10
Total:
Grand
Lodge
$32.00

New
Members

$0.00

Total:

DOB

Age

Raised

2013
2013
2013
2013
2013
2013
2013
2013
2013
2013

$0.00
AGE
18-54
$32.00

AGE
55-62
$132.00

AGE
62& UP
$250.00

$0.00

$0.00

$0.00

DOB

Age

2013
2013
2013
2013
2013
2013
2013
2013
2013
2013

1
2
3
4
5
6
7
8
9
10
Total:

2013
2013
2013
2013
2013
2013
2013
2013
2013
2013

$0.00

1
2
3
4
5
6
7
8
9
10
Members
Reinstated Since
Last Report

YRS

YRS

2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
Raised

YRS

2013
2013
2013
2013
2013
2013
2013
2013
2013
2013

ANNUAL REPORT YEAR 2013

BENEFICIARY MEMBERS OF
LODGE NO.:
NAME OF COUNTY:
DAY AND TIME OF MEETING:
YEAR BEGINNING DECEMBER 1, 2012

AND ENDING NOVEMBER 30, 2013

DIED SINCE LAST REPORT ( Month, Date and Year)

1
2
3
4
5
6
7
8

9
10
11
12
13
14
15
16

17
18
19
20
21
22
23
24

SUSPENDED MEMBERS, (Month, Date and Year)

1
2
3
4
5
6
7
8

9
10
11
12
13
14
15
16

17
18
19
20
21
22
23
24

NAME OF DELEGATE TO THE

GRAND LODGE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Vol. No.
Vol. No.

Worshipful Master
Senior Warden:
Junior Warden:
Past Master:
Past Master:
Past Master:
Past Master:
Past Master:
Past Master:
Past Master:
Past Master:
Past Master:
Past Master:
Past Master:
Past Master:
Past Master:
Past Master:
Past Master:
Past Master:
Past Master:

0
0
0

RECAPITULATION
1.
2.
3.
4.
5.
6.
7.
8
9.

Total Building Funds:

Members Reported Last Year:
Suspended During This Year:
Died During This Year:
Balance:
Reinstated During Last Year:
Admitted by Card:
New Members:
Total Beneficial Members:

(LESS LIFE MEMBERS)

(LESS LIFE MEMBERS)

Dues:
Charity:
Building Fund:
Life Membership:
NAACP
Relief Fund
Demit In State:
Demit Out of State:
New Members
Reinstated Members:
(18-54)
(55-62)
(62-UP)

_______
_______

WORSHIPFUL MASTER & SECRETARY

NAME & ADDRESS

GRAND TOTAL

Signed:
Name:
Address:
City:
State:
Zip Code:

W.M.

Signed:
Name:
Address:
City:
State:
Zip Code:
Updated: 1/3/2012

Sec.

Lodge's Seal

$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

$0.00

0
0
0
0
0
0
0
0
0

INSTRUCTIONS FOR FILLING OUT THE ANNUAL REPORT

Before attempting to complete the report, please consult the record of your Lodge to ascertain the
exact financial standing of each member. It is also necessary for you to acquiant yourselves with
Article 13 (XIII), Section 7 as it relates to the election of officers, which must be done in time to put
on the report.
Complete the following using black in ink (Confirm for accuracy, date, sign and affix lodge's seal):
a. Annual report year
b. Lodge name and address
c. Elected officers - Note the outgoing WM and Secretary must sign report w/lodge's seal.
d. Lodge Members - Type "Life Member" after the qualified member's name.
e. List each member of the lodge plus: $14, $7, $5, $4,$1, $1 date of birth, date raised and
name ofdonee. Put an asterick (*) beside each past master's name
f. Name of Each Demitted Members and the following: Lodge #, and appropriate $, date of birth,
date raised and name of donee.
g. Name of each new member - First column $32.00, birth date, raised date and donee.
h. Name of each reinstated member-Based on the member's age put appropriate $ amount.
plus, date of birth, date raised and name of donee.
i Name of each suspended member
j. Name of each member that died since last report to include the month, date and year.
k. Fill recapitulation items 2 through 8
Mail two copies of the completed report to McDuffie Bartelle, R.W. Grand Secretary, Most
Worshipful Prince Hall Grand Lodge, P. O. Box 992, Columbia, SC 29202 by the 1st of December
each year.

THIS FORM CAN NOT BE EDITED IN ANY MANNER OTHER THAN DESIGNED
PRINT THE FORM IN SINGLE PAGES

10

Donee

11

Donee

12

13

14

15

16

Donee

Donee

Donee

17

18

19

20