NOMINATION FOR APPOINTMENT

AS FINANCIAL SECRETARY

Please return completed form promptly to:Carl A. Anderson, Supreme KnightKnights of ColumbusAttn: Financial Secretary Department1 Columbus PlazaNew Haven, Connecticut 06510-3326 U.S.A.

WORTHY SUPREME KNIGHT:I submit the following member(s) for your consideration in appointing the Financial Secretary of

Council No. located at

Date Signed Grand Knight

Address City/Town

Zip Code State/Province E-mail Address

Signed

Signed

Signed

MEMBER NOMINATED(Print)

Full Name Street

City State Zip

NOTE: Question 4 does not apply in Cuba, Panama, Canal Zone, Philippines, Virgin Islands, Poland or Guatamala.

SIGNATURES OF TRUSTEES ARE REQUIRED.

ElectedRe-elected{

NOTE: The Financial Secretary:

1. Shall be a Third Degree Member;

2. Shall be appointed by the Supreme Knight, for a three-yearterm with performance subject toreview before reappointment

3. Shall be at least 21 years of age,

4. Shall not be engaged in the sale of life or health insurance

5. Shall not hold another officer position within the council.

6. Shall not have a criminal record.

103 1/09

MAIL ADDRESS

WE, THE COUNCIL BOARD OF TRUSTEES, CONCUR WITH THE NOMINATION OF THE GRAND KNIGHT:

City/Town State/Province

Yes No

Dues paid to:

Yes No

If NO when will he

receive Third Degree?

Yes No

#If YES, whatoffice did he

hold?

Yes No

DATE DATE OFFICE

HAVE YOU ENTERED YOUR COUNCIL NUMBER ON THE LINE ABOVE?

IS HE NOW THIRD DEGREE MEMBER? **

DOES HE SELL LIFE OR HEALTH

INSURANCE?

IS HE IN GOOD STANDING

IN COUNCIL?

WAS HE EVER F.S., TREAS,OR K.C. INS. AGT? #