Form Lm-4 - Labor Organization Annual Report - 2000 printable pdf download

Form Lm-4 - Labor Organization Annual Report - 2000

U.S. Department of Labor

Form Approved

FORM LM-4 LABOR ORGANIZATION ANNUAL REPORT

Employment Standards Administration

Office of Management and Budget

Office of Labor-Management Standards

No. 1215-0188

FOR USE ONLY BY LABOR ORGANIZATIONS WITH LESS THAN $10,000 IN TOTAL ANNUAL RECEIPTS

Washington, DC 20210

Expires: 12-31-2010

This report is mandatory under P.L. 86-257, as amended. Failure to comply may result in criminal prosecution, fines, or civil penalties as provided by 29 U.S.C. 439 or 440.

READ THE INSTRUCTIONS CAREFULLY BEFORE PREPARING THIS REPORT

For Official Use Only

1. FILE NUMBER

2. PERIOD COVERED

(a) AMENDED – If this is an amended report correcting a previously filed

MON

DAY

YEAR

report, check here:

(b) TERMINAL – If your organization ceased to exist and this is its terminal

From

report, see section XII of the instructions and check here:

Through

4. AFFILIATION OR ORGANIZATION NAME

8. MAILING ADDRESS (Type or print in capital letters)

First Name

Last Name

5. DESIGNATION (Local, Lodge, etc.)

6. DESIGNATION NUMBER

P.O. Box – Building and Room Number (if any)

7. UNIT NAME (if any)

Number and Street

City

State

ZIP Code + 4

19. ADDITIONAL INFORMATION

Each of the undersigned, duly authorized officers of the above labor organization, declares, under penalty of perjury and other 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.)

20.SIGNED:

21. SIGNED:

__________________________________________

___________________________________________

(If other title, see

________________________ ________________________

instructions.)

Date

Telephone Number

Date

Telephone Number