Form LM-1 Form LM-1 Labor Organization Information Report

U.S. Department of Labor
Office of Labor-Management
Standards
Washington, DC 20210

FORM LM-1
LABOR ORGANIZATION INFORMATION REPORT

For Official Use Only

This report is mandatory under P.L. 86-257, as amended. Failure to comply may result in
criminal prosecution, fines, or civil penalties as provided by 29 U.S.C. 439 or 440.

Form approved
Office of Management
and Budget
No. 1215-0188
Expires 11-30-2006

READ THE INSTRUCTIONS CAREFULLY BEFORE PREPARING THIS REPORT.

Identification Items (To be completed by all filers)
2. What is your organization's fiscal year ending date?

1. File Number
3. Is this the first Form LM-1 your organization has filed?
Yes, this is an INITIAL FORM LM-1.

No, this is an AMENDED FORM LM-1.
(Complete Items 1 through 9, 18, 20, and 21.)

(Complete Items 2 through 21.)

5. Designation (Local, Lodge, etc.)

4. Affiliation or Organization Name

7. Unit Name (if any)

6. Designation Number
Prefix

Number

Suffix

8. Mailing Address

9. Any other address where records necessary to verify this report are kept:

Name

Name

Title

Title
Organization

P.O. Box, Bldg., and Room No., if any

P.O. Box, Bldg., and Room No., if any
Street

Street

City

City

State

ZIP Code + 4

State

ZIP Code + 4

Signatures
Each of the undersigned, duly authorized officers of the above labor organization, declares, under penalty of perjury and other applicable penalties of law, that
all of the information submitted in this report (including the information contained in any accompanying documents) has been examined by the signatory and is,
to the best of the undersigned's knowledge and belief, true, correct, and complete. (See the section on penalties in the instructions.)

President
(if other title, see
instructions)

20. Signed

President

On

Secretary
(if other title, see
instructions)

Secretary

On
Date

Form LM-1 (2003)

21. Signed

Telephone Number

Date

Print Report

Telephone Number

Page 1 of 3

File Number

Name of Labor Organization

Information Items (To be completed by initial filers only)
10. Where is your organization chartered to operate?

11. When is your organization's next regular election of officers?

County

City

State

Month

13. Is your organization:

12. Are any of your organization's members:
Private Industry Employees

A Local, Lodge, Branch, etc.

U.S. Postal Service Employees

An Intermediate Body (a conference,
general committee, joint board, system
board, joint council, district, etc.)

Federal Government Employees

A National or International

(Check as many boxes as are applicable)

Year
14. What are your organization's expected
annual receipts (dues, fees, etc.):
Less than $10,000
$10,000 - 199,999
$200,000 or more

15. List the names and titles of all your organization's officers.
Name

Title

Add More Names & Titles

16. What are your organization's rates of dues and fees? (Enter a minimum and maximum if more than one rate applies for any line.)
a. Regular Dues/Fees $

per

Minimum

Maximum

(month, year, etc.)

b. Working Dues

$

Minimum

Maximum

c. Initiation Fees

$

Minimum

Maximum

d. Transfer Fees

$

Minimum

Maximum

e. Work Permits

$

Minimum

Maximum

per
(month, year, etc.)

17. Two copies of your organization's current constitution and bylaws must be filed with this report. Under certain circumstances, your parent national or
international organization may file copies on your behalf (see the instructions for this item). Is your parent national or international submitting copies on your
behalf?
Yes

No

If your organization is filing any governing documents with this report, list them below.

Form LM-1 (2003)

Add More Item 17 Information

Page 2 of 3

Name of Labor Organization

File Number

Practices and Procedures (To be completed by all filers except Federal employee labor organizations subject solely to Title VII of the Civil Service Reform Act
or Chapter 10 of the Foreign Service Act)
18. Enter in Column (1) the page number and section or paragraph number of your organization's constitution and bylaws where the listed practice or
procedure is described. Or, if not described in the constitution and bylaws, check the box in Column (2) and provide a description of the practice or procedure in
Item 19 or on an attached page.

Practice or Procedure
a. Qualifications for or restrictions on membership
b. Levying assessments
c. Participating in insurance or other benefit plans
d. Authorizing disbursement of labor organization funds
e. Auditing financial transactions of the labor organization
f. Calling regular and special meetings

(1)
Page, Section, and/or Paragraph Number of Constitution and Bylaws

(2)
Described
in Item 19
a.
b.
c.
d.
e.
f.

g.1. Selecting officers and stewards and any representatives to other
bodies composed of labor organizations' representatives

g.1.

g.2. Invoking procedures by which a member may protest a defect in
the election of officers (including not only all procedures for
initiating an election protest but also all procedures for
subsequently appealing an adverse decision, for example,
procedures for appeals to superior or parent bodies, if any)

g.2.

h. Disciplining or removing officers or agents for breaches of their trust
h.
i. Imposing fines and suspending or expelling members including the
grounds for such action and any provision made for notice, hearing,
judgment on the evidence, and appeal procedures
j. Authorizing bargaining demands
k. Ratifying contract terms
l. Authorizing strikes
m. Issuing work permits

i.
j.
k.
l.
m.

Additional Information (To be completed by all filers, as necessary)
19. Additional Information
Item
Number
Item
Number

Form LM-1 (2003)

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