Page 2 - Please use this to submit Quarterly, Semi-Annual and Annual reports. Division Name_________________________________________ Division Number_______________________________________ County_______________________________________________ Number of Members in Division___________________________ Date Recipient $ Amount or Hours ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ ___________________________________ _________________ Person Submitting This Report____________________________ Address______________________________________________ City, State and Zip_____________________________________ Mail To: Arnold J. Nagelhout 8422 Munson Avenue Niagra Falls, NY 14304-3441 |
