Application for Per Capita
Disability Exemption
1831 3/22
Council No. __________________
This is to certify that ____________________________________, ________________, is a
(Member Name) (Member Number)
member in good standing in this council and that he is eligible for relief from payment of all council
dues and Supreme and state council per capita taxes, due to total disability, as authorized by
Section 118(e) of the Charter, Constitution, and Laws of the Knights of Columbus.
Attest: ______________________________ ____________________________________
Financial Secretary Grand Knight
Dated ______________________________
Submit completed form to
Notes: If the application is approved, dues and per capita shall be waived until the financial
secretary notifies that the exemption should be rescinded. Membership
that is continued under the provisions of Section 1
18(e) shall be construed as active membership
in computing the membership requirement for recognition as honorary or honorary life
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