Form LM-2

U.S. Department of Labor
Office of Labor-Management Standards
Washington, DC 20210

FORM LM-2

Form approved
Office of Management
and Budget
No. 1214-0001
Expires 12-31-96

LABOR ORGANIZATION ANNUAL REPORT

MUST BE USED BY LABOR ORGANIZATIONS WITH $200,000 OR MORE IN TOTAL ANNUAL RECEIPTS AND LABOR ORGANIZATIONS UNDER TRUSTEESHIP

This report is mandatory under PL. 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. SUBMIT THIS REPORT IN DUPLICATE.

IMPORTANT

1. FILE NUMBER

It a label is here, peel off the top copy and place it in the same box on the second copy of the form If label information is correct, leave Items 4 through 8 blank. If label information is incorrect, complete Items 4 through 8.

2. PERIOD COVERED

MO	DAY	YR

From

Through

3. If your organization ceased to exist and this is its terminal report, see Section XII of the instructions and
check here

4. AFFILIATION OR ORGANIZATION NAME

8. MAILING ADDRESS
(in care of) NAME AND TITLE OF PERSON

5. DESIGNATION (Local, Lodge, etc.)

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

CITY

STATE

ZIPCODE

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?

Rates of Dues and Fees

14. Have an audit or review of its books and records by an outside accountant or by a parent body auditor/representative?

(a) Regular Dues/Fees

per

(month, year, etc )

15. Discover any loss or shortage of funds or other property? (Answer slyest even if there has been repayment or recovery)

(b) Initiation Fees

$
$

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?

(d) Work Permits

per

(month, year, etc )

1 7. 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.)

Yes

(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.)

76. SIGNEDPRESIDENT (If other tit/e, see instructions)

Date Telephone Number

77. SIGNEDTREASURER (If other tit/e,see instructions)

Date Telephone Number

Form LM-2 (Revised 1994)

Page 1 of 6

ENTER AMOUNTS IN DOLLARS ONLY

FILE NUMBER

COMPLETE SCHEDULES 1 THROUGH 15 BEFORE COMPLETING STATEMENTS A AND B

STATEMENT A -- ASSETS AND LIABILITIES

ASSETS Item	From SCH #	Start of Reporting Period (A)	End of Reporting Period (B)	LIABILITIES Item	From SCH #	Start of Reporting Period (C)	End of Reporting Period (D)
25. Cash				33. Accounts Payable
26. Accounts Receivable				34. Loans Payable	8
27. Loans Receivable	1			35. Mortgages Payable
28. U.S. Treasury Securities				36. Other Liabilities	4
29. Investments	2			37. TOTAL LIABILITIES
30. Fixed Assets	5
31. Other Assets	3
32. TOTAL ASSETS				38. NET ASSETS (Item 32 less Item 37)

STATEMENT B - RECEIPTS AND DISBURSEMENTS
CASH RECEIPTS Item	From SCH #	AMOUNT	CASH DISBURSEMENTS Item	From SCH #	AMOUNT
39. Dues			56. To Officers	9
40. Per Capita Tax			5 7. To Employees	10
41. Fees			58. Per Capita Tax
42. Fines			59. Fees, Fines, Assessments, etc
43. Assessments			60. Office & Administrative Expense	13
44. Work Permits			61. Educational & Publicity Expense
45. Sale of Supplies			62. Professional Fees
46. Interest			63. Benefits	11
4 7. Dividends			64. Contributions, Gifts & Grants	12
48. Rents			65. Supplies for Resale
49. Sale of Investments & Fixed Assets	6		66. Direct Taxes
50. Loans Obtained	8		6 7. Withholding Taxes
51. Repayments of Loans Made	1		68. Purchase of Investments & Fixed Assets	7
52. On Behalf of Affiliates for Transmittal			69. Loans Made	1
to Them			7 0. Repayment of Loans Obtained	8
53. From Members for Disbursement on Their Behalf			7 1. To Affiliates of Funds Collected on Their Behalf
54. Other Receipts	14		7 2. On Behalf of Individual Members
			7 3. Other Disbursements	15
55. TOTAL RECEIPTS			7 4. TOTAL DISBURSEMENTS

7 5. ADDITIONAL INFORMATION (if more space is needed, attach additional pages properly identified.)
Item Number
Form LM-2 (Revised 1994)					Page 2 of 6

LM-2
If more space is needed to complete any of the schedules, continue on additional pages, using the same column headings used on the schedule, and enter the totals on the line provided for additional pages in each schedule.					FILE NUMBER
SCHEDULE 1 - LOANS RECEIVABLE
List below loans to officers, employees, or members which at any time during the reporting period exceeded $250 and list all loans to business enterprises regardless of amount. (A)	Loans Outstanding at Start of Period (B)	Loans Made During Period (C)	Repayments Received Cash (D)(1 )	During Period Other Than Cash) (D)(2	Loans Outstanding at End of Period (E)
1. Name:
Purpose:
Security:
Terms of Repayment:
2. Name:
Purpose:
Security:
Terms of Repayment:
3. Totals from additional pages (if any
4. Totals of loans not listed above
5. Totals of Lines 1 through 4
Enter the Totals from Line 5 in	Item 27, Column (A)	Item 69	Item 51	Item 75 with Explanation	Item 27, Column (B)

SCHEDULE 2 - INVESTMENTS (OTHER THAN U.S. TREASURY SECURITIES)
Description (A)	Amount (B)
Marketable Securities 1. Total Cost
2. Total Book Value
3. List each marketable security which has a book value over $1,000 and exceeds 20% of Line 2.
(a)
(b)
(c)
(d)
Other Investments 4. Total Cost

5. Total Book Value
6. List each other investment which has a book value over$1,000 and exceeds 20% of Line 5. Also list each subsidiary for which separate reports are attached.	Amount (B)
(a)
(b)
(c)
(d)
(e) Total from additional pages (if any)
7. Total of Lines 2 and 5
Enter the Total from Line 7....... ....in Item 29, Column (B)

SCHEDULE 3 - OTHER ASSETS
Description (A)	Book Value (B)
1.
2.
3.
4.
5. Total from additional pages (if any)
6. Total of Lines 1 through 5
Enter the Total from Line 6 in	Item 31, Column (B)

SCHEDULE 4 - OTHER LIABILITIES
Description (A)	Amount at End of Period (B)
1.
2.
3.
4.
5.
6.
7.
8. Total from additional pages (if any)
9. Total of Lines 1 through 8
Enter the Total from Line 9 in	Item 36. Column (D)

Form LM-2 (Revised 1994)

Page 3 of 6

			FILE NUMBER
SCHEDULE 5 - FIXED ASSETS
Description (A)	Cost or Other Basis (B)	Total Depreciation or Amount Expensed (C)	Book Value (D)	Fair Market Value (E)
1. Land (give location):
2. Totals from additional pages (if any)
3. Buildings (give location):
4. Totals from additional pages (if any)
5. Automobiles and Other Vehicles
6. Office Furniture and Equipment
7. Other Fixed Assets
8. Totals of Lines 1 through 7
Enter the Total from Line 8, Column (D) in			Item 30, Column (B)

SCHEDULE 6 - SALE OF INVESTMENTS AND FIXED ASSETS
Description (if land or buildings, give location) (A)	Cost (B)	Book Value (C)	Gross Sales Price (D)	Amount Received (E)
1.
2.
3.
4.
5. Totals from additional pages (if any)
6. Totals of Lines 1 through 5
			7. Less Reinvestments
			8. Net Sales
Enter the Total from Line 8 in				Item 49

SCHEDULE 7 - PURCHASE OF INVESTMENTS AND FIXED ASSETS
Description (if land or buildings, give location) (A)	Cost (B)	Book Value (C)	Cash Paid (D)
1.
2.
3.
4.
5. Totals from additional pages (if any)
6. Totals of Lines 1 through 5
		7. Less Reinvestments
		8. Net Purchases
Enter the Total from Line 8 in			Item 68

SCHEDULE 8 -LOANS PAYABLE
			Repayments Made During Period
Source of Loans Payable at Any Time During the Reporting Period (A)	Loans Owed at Start of Period (B)	Loans Obtained During Period (C)	Cash (D)(1 )	Other Than Cash (D)(2)	Loans Owed at End of Period (E)
1.
2.
3.
4. Totals from additional pages (if any)
5. Totals of Lines 1 through 4
Enter the Totals from Line 5 in	Item 34, Column (C)	Item 50	Item 70	Item 75 with Explanation	Item 34, Column (D)

Form LM-2 2 (Revised 1994)


LM-2	SCHEDULE 9 - ALL OFFICERS AND DISBURSEMENTS TO OFFICERS				FILE NUMBER
Name ( List all persons who held office during the reporting period even if they received no salary or other disbursements.) (A)	Title (B)	S t a t u s (C)	Gross Salary (before taxes and other deductions) (D)	Other Disbursements (E)	Allowances (F)	Disbursements for Official Business (G)	Total (H)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10. Totals from additional pages (if any)
11. Totals of Lines 1 through 10
					12. Less Deductions
					13. Net Disbursements
Enter the Total from Line 13 in							Item 56
Code for Column (C): past officer -- P; continuing officer-C; new officer during the reporting period -- N. (If any officer was not elected at a regular election in accordance with your organization's constitution and bylaws, explain in Item 75. )


SCHEDULE 10 - DISBURSEMENTS TO EMPLOYEES
Name (List all employees who received more than $10,000 in total disbursements from your organization and any affiliates.) (A)	Position (B)	Name of Affiliated Organization (if applicable) (C)	Gross Salary (before taxes and other deductions) (D)	Allowances (E)	Disbursements for Official Business (F)	Other Disbursements (G)	Total (H)
1.
2.
3.
4.
5.
6.
7.
8.
9. Totals from additional pages (if any)
10. Totals for all employees who, during the reporting period, received $10,000 or less in total disbursements from your organization and any affiliates
11. Totals of Lines 1 through 10
					12. Less Deductions
					13. Net Disbursements
Enter the Total from Line 13 in							Item 57
Form LM-2 (Revised 1994)							Page 5 of 6

SCHEDULE 11 - BENEFITS		FILE NUMBER
Description (A)	To Whom Paid (B)		Amount (C)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10. Total from additional pages (if any)
11. Total of Lines 1 through 10
Enter the Total from Line 11 in			Item 63

SCHEDULE 12 - CONTRIBUTIONS, GIFTS & GRANTS
Description (A)	Amount (B)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10. Total from additional pages (if any)
11. Total of Lines 1 through 10
Enter the Total from Line 11 in	Item 64

SCHEDULE 13 - OFFICE & ADMINISTRATIVE EXPENSE
Description (A)	Amount (B)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10. Total from additional pages (if any)
11. Total of Lines 1 through 10
Enter the Total from Line 11 in	Item 60

SCHEDULE 14 - OTHER RECEIPTS
Description (A)	Amount (B)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10. Total from additional pages (if any)
11. Total of Lines 1 through 10
Enter the Total from Line 11 in	Item 54

SCHEDULE 15 - OTHER DISBURSEMENTS
Description (A)	Amount (B)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10. Total from additional pages (if any)
11. Total of Lines 1 through 10
Enter the Total from Line 11 in	Item 73
Form LM-2 revised 1994)	Page 6 of 6