Fillable Jack and Jill of America, Incorporated

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Jack and Jill of America, Incorporated

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National Per Capita Tax Report
This form can be used to transmit per capita tax for all members.
1930 17th Street, NW Washington, DC 20009 | www.jackandjillinc.org | (202) 667-7010
Since 1938
Jack and Jill of America, Incorporated
Members
Associates
New National Life Members
National Convention Assessment Fee
Late Fee ($100 after October 1)
Chapter Bonding Fee
$92/ea
$92/ea
$20/ea
$50
Total:
Item Total
NationalItem
Chapter Information
Membership Summary and Census
Signatures
A
Chapter State Region Year
B
C
Financial Secretary
President
Number
$250/ea (20-yr member)
$350/ea (15-yr member)
$450/ea (10-yr member)
Children Male: Female:
Teens Male: Female:
Please indicate the quantity of each in your chapter:
$ 50
Send payment and this form to National
Headquarters:
Jack and Jill of America, Incorporated
Attn: National Treasurer
1930 17th Street, NW
Washington, DC 20009
Note: Retain one copy for your chapter
records and submit electronically to
finance@jack-and-jill.org.
Treasurer
Date
Date
Date
0
0
0
0
0
0
50
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Jack and Jill of America, Incorporated

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Completed 1 July 2021

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