NOTICE OF INSTITUTION OF NEW COUNCIL
The name selected and adopted for this new council is
To the Supreme Knight and Supreme Secretary, Knights of Columbus:
This is to certify that I have this day,
at the parish of
FIRST DEGREES have been exemplified as follows:
Date Location No. Candidates
Total
Transfers (indicate number)
Former Members (indicate number)
Grand Total
Please send council supplies to acting Grand Knight
at
NOTE — Canada Only: Please indicate language preference based on majority of membership.
Insurance Department Representative assisted in institution of this council.
(minimum 30)
Date—Form 100’s
mailed to home office
, instituted a new council
.
.
in the diocese of
Council Location:
Jurisdiction:
CITY
NAME
NAME
STREET CITY ZIP CODE
French English
FORM 136
11/ 03
Signed:
DATEDISRICT DEPUTY
Mail Original To: Supreme Office Mail Copies To: State Deputy
State NCD Chairman
District Deputy
