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Knights of Columbus 

Pennsylvania Central District

Fourth Degree 

REPORT OF ASSEMBLY OFFICERS CHOSEN FOR THE TERM

    Assembly Number


    July 1st thru June 30th



    Date of Election




    Assembly Location

    City:   State:   Zip:


    Faithful Navigator

    Membership #    Last Name:    First Name:   Initial:    Council #

    Address Change

    Street:    City:    State:    Zip:

    Area Code:    Phone Number:


    Faithful Comptroller

    Membership #    Last Name:    First Name:   Initial:    Council #

    Address Change

    Street:    City:    State:    Zip:

    Area Code:    Phone Number:


    Faithful Friar

    Membership #    Last Name:    First Name:   Initial:    Council #

    Address Change

    Street:    City:    State:    Zip:


    Faithful Captain

    Membership #    Last Name:    First Name:   Initial:    Council #

    Address Change

    Street:    City:    State:    Zip:


    Faithful Admiral

    Membership #    Last Name:    First Name:   Initial:    Council #

    Address Change

    Street:    City:    State:    Zip:


    Faithful Purser

    Membership #    Last Name:    First Name:   Initial:    Council #

    Address Change

    Street:    City:    State:    Zip:


    Faithful Pilot

    Membership #    Last Name:    First Name:   Initial:    Council #

    Address Change

    Street:    City:    State:    Zip:


    Faithful Scribe

    Membership #    Last Name:    First Name:   Initial:    Council #

    Address Change

    Street:    City:    State:    Zip:


    Inner Sentinel

    Membership #    Last Name:    First Name:   Initial:    Council #


    Outer Sentinel

    Membership #    Last Name:    First Name:   Initial:    Council #


    One Year Trustee

    Membership #    Last Name:    First Name:   Initial:    Council #


    Two Year Trustee

    Membership #    Last Name:    First Name:   Initial:    Council #


    Three Year Trustee

    Membership #    Last Name:    First Name:   Initial:    Council #



    Assembly Meets:


    Signed Faithful Comptroller:   Membership Number:



    By submitting this form I certify that all information is accurate to the best of my knowledge.

    I acknowledge clicking submit, will submit this form to the District Master, Vice Supreme Master, State Deputy, and Supreme Secretary.

    Please verify all information before submitting.



    Current Office Held (required):


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