APPLICATION FOR RELIEF FROM PAYMENT
OF COUNCIL DUES AND SUPREME AND
STATE COUNCIL PER CAPITA TAXES
I hereby certify that I, ____________________________________, _______________________
Name Address
____________________________, am a member in good standing of Council No. _________
and that I am totally disabled and hereby request that I be relieved of payment of all
council dues and Supreme and state council per capita taxes under Section 118(e) of
the Laws of the Order. In support of this request, I submit one of the following as
evidence of my total disability:
()Certification from Health and Human Services, or
()Certification from Internal Revenue Service, or
()Certification from Veterans’ Administration, or
()Certification from attending physician.
Dated
_________________________ _______________________________________
Member Signature
CERTIFICATION OF COUNCIL
Council No. __________________
Location ____________________________________
This is to certify that ________________________________________________, _______
__________,
Name Membership Number
is a member in good standing in this council and that he has presented evidence of total
disability that warrants consideration for relief from payment of all council dues and
Supreme and state council per capita taxes, under Section 118(e).
Attest: _______________________________ ________________________________________
Financial Secretary Grand Knight
Dated _____________________________
(affix council seal here)
INSTRUCTIONS TO FINANCIAL SECRETARY: Forward completed form with applicant
and officer signatures and accompanying proof of disability to: Knights of Columbus,
Department of Membership Records, 1 Columbus Plaza, New Haven CT 06510-3326.
NOTICE: Approval of this application for dues consideration does not have any effect on the waiver of insurance
contributions on an insurance certificate held by the member.
1831 1-01
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Disability Exemption Guidelines
At the Supreme Council meeting held in Chicago, Illinois, Aug. 5-6-7, 1986, Section 118(e) of the
Order’s Laws was amended to read as follows:
(e) Any member who is disabled by bodily injuries or disease and is thereby
prevented from engaging in any occupation or employment for remuneration or
profit and shall have been so prevented for a period of no less than six
consecutive months may, on due request in writing to the Supreme Council
and upon certification by evidence satisfactory to the Supreme Council of such
disability, be relieved from the payment of all council dues and Supreme and
state per capita taxes as of the date of approval of said request and any
suspension of such member for non-payment of such dues and tax shall cease
as of the date of such approval.
Application for relief under Section 118(e) shall be made as follows:
1. The Application, Form 1831, shall be completed by the member and attested to by the grand
knight and financial secretary.
2. The application shall be submitted to the Supreme Secretary with one of the following as
evidence of total disability:
Certification from Health and Human Services, or
Certification from Internal Revenue Service, or
Certification from Veterans’ Administration, or
Certification from attending physician.
3. The application and supporting evidence shall be considered by a committee comprised of the
Supreme Secretary, Supreme Advocate and Supreme Physician. Their decision may be appealed to the
Board of Directors by the applicant only.
4. If the application is approved, dues and per capita shall be waived until the following Dec. 31.
5. Application for renewal of relief under Section 118(e) shall be as follows:
a. The Supreme Secretary shall provide each council with a list of its members shown on Supreme
Council records as exempt from payment of dues and per capita taxes as of Oct. 1 of each year;
b. The grand knight and financial secretary shall certify to each member’s continuing disability by
signing the form;
c. The financial secretary shall forward the renewal to the Supreme Secretary;
d. Upon receipt of the properly completed form by the Supreme Secretary, he shall continue the
dues and per capita waiver under Section 118(e);
e. If the grand knight and financial secretary fail to certify the continuing disability of any member
within the 90-day period, the waiver of dues and per capita charges shall terminate.
6. Where an application for relief under Section 118(e) is filed on a member duly qualified for recognition
as an honorary life member, the Supreme Secretary shall record said application under Section 118(d).
7. Membership that is continued under the provisions of Section 118(e) shall be construed as active
membership in computing the membership requirement for recognition as honorary or honorary life
membership.
8. Approval of an application for relief under Section 118(e) does not have any affect on waiver of
insurance contributions on an insurance certificate held by the member.
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