NC Official Form 23
Official Form of Delinquency
Lodge No.
AF. & AM
, NC
Mr.
Dear Brother
Complying with the requirements of Regulation 77-19 of The Code of the Grand Lodge
of Ancient, Free and Accepted Masons of North Carolina, I Herewith inform you that the
amount owing to this lodge on this date is as follows:
Arrears
Dues for ______ (year)$_____________
Current
Dues for ______ (year)$_____________
You are hereby notified that unless the full amount is paid on or before October 1, you
must show cause why you should not be excluded for nonpayment of dues, or the lodge
will, after that date, consider and act upon your delinquency.
Please take due notice of this situation.
Fraternally yours,
seal _____________________________
Master
ATTEST:
_________________________________
Secretary
Notes: 1. This notice must be used in connection with the Reg. 77-19 in the third quarter (July 1 - September 30)
each year.
2. The notice and the name of the master may be written, printed, or copied by similar process, however the
Secretary must sign his name and affix the seal of the lodge thereto.
3. This form must be sent to the last known address of the member by first class mail in a sealed envelope
with return address thereon. Registration is not required, but may be used