Home Servants' Monthly Report Form

May 28, 2003

[First published] 1978DO No.670R

[HomeARC note (10/98): This form has been updated to reflect Charter requirements. This file is presented for archival purposes.]

Please fill out on the last day of each month and send copies as follows: Original + 1st copy of this form to your KQS along with tithes and special donations; 2nd copy to Service Center Servant; 3rd copy for your file. If additional space is required for any section, please use an additional sheet of paper. Please type whenever possible or print neatly with ballpoint pen in English if possible. Thanks! GBY!—Love, M&M, WS & All. "Visit our brethren in every city ... and see how they do."—Acts 15:36.

I. HOME NAME:_______________

  1. PERIOD ENDING_____________________ Day / Month / Year
  2. [ ] Please check this box if this is the first report from your new Home in a new location.
  3. [ ] Please check this box if your Home mailing address or Servant has changed since your last report.

(Check which of these Servants speak the local language well) Please check this box if you are a:

4) Servant + Handmaiden __________________________

First and Last Bible Names

5) Servant + Handmaiden _________________________

First and last Legal Names

6) Street Address______________________________________________

(Please give your full street address exactly as it should appear on our files)

7) Address Mail to:_____________________________________________

(Please give your complete mailing name and address exactly as it should appear on your mail)

8) Names of your Home Visiting Servants:__________________________

First and Last Bible Names

9) Date of Last Visit:_______________________

10) Public Phone No._______________________

Area Code Number

11) Private Phone No._______________________

Area Code Number

II. PERSONNEL

(IMPORTANT: Please put a check mark next to each person's name who is new to your Family since your last report. Include all personnel presently based at your Home in the space below. Temporary guests need not be included. This form is to be use by both Live-in and Catacomb Families. Live-in Homes please list Catacombers on Page 2, Section IX.)

BIBLE NAME LEGAL NAME SEX AGE JOB Passport Nationality/ Country of Birth

1._______________________________

2._______________________________

3._______________________________

4._______________________________

5._______________________________

6._______________________________

7._______________________________

8._______________________________

9._______________________________

10._______________________________

11._______________________________

12._______________________________

III. POPULATION

1) No. of mated men (live-in)

2) No. of mated women (live-in)

3) Single men (12 yrs + over, live-in)

4) Single women (12 yrs + over, live–in)

TOTAL ADULTS (live-in)

5) Total Boys (children under 12)

6) Total Girls (children under 12)

7) TOTAL CHILDREN (Total boys + Total girls)

8) TOTAL LIVE–IN MEMBERS (Tot. children + Tot. Adults)

9) TOTAL CATACOMB DISCIPLES

10) TOTAL FAMILY MEMBERSHIP (Cat. + Live–in)

POPULATION BREAKDOWN (Please include your "Total Family Membership" both Live in and Catacomb Disciples.)

11) Babies (from newborn to 2 yr.)

12) Toddlers (2 to 5 yrs.)

13) Children (5 to 8 yrs.)

14) Children (8 to 12 yrs.)

15) Adult Leadership Trainees (Over 1 yr. in the Family)

16) Adult Disciples (Over 6 months but under 1 year)

17) Adult Babes (under 6 months in the Family)

18) BETROTHALS (give names + dates)

19) DIVORCES or permanent separations

NUMBER WITNESSED TO:

20) Mass (offered lit or saw H.G. sample)

21) Personal (shared with personally, phone or mail)

22) Visitors

23) Media (estimated outreach of TV, radio + news articles)

24) TOTAL WITNESSED TO (Mass + personal + visitors + media)

25) News Items (no. of individual printed articles)

26) No. of TV, Radio shows, broadcast news items

27) LITERATURE DISTRIBUTED

28) CONVERTS (received Jesus)

29) BAPTISMS (received Holy Ghost)

30) DEATHS (graduation—hallelujah!)

31) MISCARRIAGES (4 mo. or over)

GAINS: (New Disciples) [ ] Check this box if you have enclosed a New Disciple Personnel Form for each person listed in this section. We cannot give you credit for your new disciples without these forms! WLY!

32) New mated men (live-in)

33) New mated women (live–in)

34) New single men (live–in)

35) New single women (live–in)

36) New live-in children (newborn to 12 yrs.)

37) Births in the Family (give name, parents‚ date!)

38) New Catacomb Disciples

39) TOTAL GAINS (new disciples)

LOSSES:

40) Total Backsliders (live-ins under 1 year)

41) Total Graduates (live-ins over 1 years)

42) Total Catacomb losses

43) TOTAL LOSSES (backsliders + grads + catacombers)

44) NET GAIN or LOSS (Gains minus Losses) _________________________________

IV. CASH GIFTS RECEIVED

Amount in local currency ____________

Name local currency ________________

1) Mail Ministry Income

2) Provisioning Income

3) Lit Income from street sales

4) Income from forsake-alls

5) Income from FFing

6) Other (gifts, wages, pioneer donations, etc.)

7) TOTAL INCOME from all sources

WORLD SERVICES DONATION:

"WE WILL NEED YOUR REPORT TO KNOW WHERE YOU'RE AT, AND YOUR TITHE TO HELP US PRODUCE THE WORD." ("Proclaim Liberty!" No.696:26 by Father David.)

(List Amounts in the actual currency enclosed in this report.)

7)_______is the amount of our 10% tithe enclosed for the worldwide work and publications of our World Services‚ M + M + Staff support.

8)_______is the amount of our .5% gift to pay for our One-Per-2 Disciples mailings.

9)_______is the amount of our special gift in addition to our 10.5% to be used for (please specify):_____________________________

10)______is the amount of our total donations enclosed.

11) [ ] Check this box if you are not financially able to send a donation at this time and briefly describe why:_______

Our Family also gave the following donations:

12) Local Pioneering:________

13) Visiting Servants:_______

14) TCC:__________

15) Other:____________

We understand that a few may not be able to afford to send in their donation at this time; just give what you can to help us. Please try to be as faithful as possible to help print more MO in the future and continue to help needy fields. Thank you so much for your help in making our World Services a blessing to all! God bless and keep you and continue to make you a blessing! We love you!—M & M & ALL.

V. PLEASE ANSWER THE FOLLOWING:

_____1. How many WS mailings did you get this month? Explain any problems with mailings:

_____2. Has each person in your Home read all New MO Letters + Publications with mailings?

_____3. Has each person read at least one MO Letter each day?

_____4. Have you had at least one united meeting each day and read all new MO Letters together?

_____5. Were you visited by your Home Visiting Servants this month?

_____6. How many "No's" do you have on your Family of Love Home Checklist? (ML No.660)

_____7. Has some of your Family FFed at least once a week this month?

VI. NEW MO LETTER/OTHER PUB, REACTION

PUB NO.

VII. LIT SHINERS

NameAmt.Dist'd

1.

2.

3.

LIVE-IN DISCIPLE

NameNo. Won

4.

5.

6.

CATACOMB DISCIPLE SHINERS

NameNo. Won

7.

8.

9.

VIII. BACKSLIDERS+GRADUATES If anyone backslid or graduated from your Home, either Live-In or Catacomb, please fill out below so they can be included in a MO Mailing List. (Along with your report, please send an explanation and photo, if possible, of any undesirable backslider or graduate.)

First and Last Bible First and Last Attitude Present Address Name Legal Name

1.

2.

3.

IX. CATACOMB PERSONNEL (Please list all Catacomb Personnel based at your Home.—To be completed by Live-in-Homes only.)

Bible Name Legal Name Nationality Age Attitude

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

X. VICTORIES (Please describe your 3 greatest victories this month)

XI. PROBLEMS (Please list your 3 biggest problems, legal or otherwise, this month)

XII. HOME EXPENSES THIS PAST MONTH! (in local currency)

(Simply transfer these items from your financial records or ledger for the month—always keep one!)

1. RENT or PAYMENTS:__________________ ________________

2. FURNITURE/APPLIANCES:______________ ________________

3. FURNISHINGS (linens, bedding‚ silver‚ post‚ etc.):__ ______

4. OTHER HOUSEHOLD ITEMS (washing‚ gardening, etc.):__________

5. HOUSE REPAIRS: __________________________________

6. UTILITIES (lights, gas, fuel, water, phone, etc.):________________

7. FOOD: Groceries, vitamins & food supplements:___________

FOOD: Meals out:_____________________________________

FOOD: Wine + liquor:________________________________

8. TRANSPORT, your private vehicle:____________________

TRANSPORT, public:____________________________________

TRANSPORT, taxis:_____________________________________

9. CLOTHING (new or used + repairs):_____________________

10. SCHOOL SUPPLIES:________________________________________

11. OFFICE SUPPLIES:________________________________________

12. MEDICAL + DENTAL COSTS (medication, treatment‚ doctor, nurse, hospital‚ clinic‚ glasses, dentist, pharmacy, etc.):________

13. PERSONAL ITEMS (toiletries, kotex, perfume, misc.):____________

14. LEGAL COSTS (fines, court cases‚ lawyers, contracts, legal papers, etc.):____________

15. LIT (MO Comics + Books + LIN's etc. for distribution):________

From Service Center: ________________________________

From Gold Lion Pubs, Hong Kong: ____________

System Printed:______________________________

Printed in Our Shop:___________________________

16. FFing equipment: (dress, jewelry, perfume, make-up, shoes …, etc.):______________________________

HOME EXPENSES THIS PAST MONTH, cont'd:

FFing, expenses (transport, admissions‚ drinks, snacks, tips, rooms, etc.)___________________________________________________

17. SYSTEM READING MATERIAL (books, papers‚ magazines, etc.):________

18. TV's, RADIOS, TAPE RECORDERS, CAMERAS, TAPES‚ FILMS, BATTERIES, WATCHES, etc.:____________________

19. CINEMA MOVIES‚ PLAYS, CONCERTS, SHOWS‚ ENTERTAINMENT‚ etc.:______

20. GIFTS & TITHES:___________________________

21. TOTAL MONTH'S EXPENSES:_________________________

22. TOTAL MONTH'S INCOME:__________________________

23. TOTAL MONTH'S DIFFERENCE (+ or -):______________________

TOTAL DEBTS OWED (Describe):

XIII.a. LIT PRINTED (List here all lit your Home printed or had printed this month.—Include all CBs, Letters and LINs‚ etc.)

Number

Title

Amount

XIII.b. COMMENTS, SUGGESTION, etc. (This space is for you!):

XIV. FFing

Total members who FFed this month (even once!)

Men ____________Women ___________Total. _____________

Total no. of times FFed added together _____

(ex: John 10 + Mary 10 + Sam 5 = 25) (See scores below:)

(Times to club, bar, cafe‚ street, home, etc.)

(EACH MEMBER KEEP A FAITHFUL DAILY DIARY!)

Adult Members (over 21!) *F/M

Servant

Handmaiden

No. of Fish Given:

Light Witness *

Heavy witness

Total No. Fish Witnessed to

No. of times went FFing *

…

No. Received Jesus

No. Rec'd Baptism of Holy Spirit

No. Times You wrote Fish

No. Letters Rec'd from Fish

…

NEW PEOPLE WON BY FFing

Live-in

Catacombers

Friends

Total

GRAND TOTAL A: ________

* F or M = Female or Male

* Light Witness—anything less than heavy witness—talk about God, Bible, spiritual things.

* Heavy Witness—includes Salvation Message or Prayer or Holy Ghost or Gift of Love (Sex), etc.

* No. of times each person goes out FFing.

(KEEP A DIARY! FILE DAILY REPORTS!)

No. of Fish Given:

Light Witness

Heavy Witness

Total No. Witnessed to

…

Total No. Rec'd. Jesus

TYPES OF FISH FFed:

No. Male

No. Fem.

… (specify)

GRAND TOTAL B: ________

Please be sure Grand Totals B, C & D agree!

…

…

= GRAND TOTAL C: ________

Residence of Fish Given FF Witness:

No. Locals ________

No. Travelers ________

= GRAND TOTAL D: ________

FF COST

Total worth of Gifts rec'd. from Fish this month (drinks, transport, food, clothing, furniture, housing …, trips, etc.) $

Total Spent this month on FFing (clothes, jewelry, perfume, transport, admission, drinks, etc.) $

Average Cost per FFer (total amount above divided by no. of FFers FFing this month) $

Average Cost per Fish Witnessed to (Total cost for FFing for month divided by no. fish witnessed to) $

Average Cost per Fish saved thru FFing (Total cost for FFing for month divided by no. Fish Saved)

NET GAIN OR LOSS (Subtract Total Spent from Total Gifts above) $

NAMES OF TOP 3 FF WINNERS OF THE MONTH No. Souls Won FFing

1st

2nd

3rd

NAMES OF TOP 3 FF LOVERS OF THE MONTH (SEX)

…

1st

2nd

3rd

…

Use this space to describe your best FFing experiences of the month and any special FF problems of the month and/or solutions if any.

XV. CHECKLIST: THIS MONTH'S HOME CHECKLIST SCORE: TOTAL No. of NO's

(Circle the number or letter of each "No" you had on this month's checklist:)

I.A. BEDROOMS: 1 2 3 4 5 6 7 8 9 10 11 12 13 14.

B. KITCHEN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18.

C. HEATING: 1 2 3 4 5 6.

D. TOILET: 1 2 3 4 5 6 7 8 9 10 11.

E. LIGHT: 1 2 3 4.

F. LV.RM. 1 2 3 4 5 6 7 8 9 10 11 12.

G. LAUNDRY: 1 2 3 4 5 6.

H. TRASH: 1 2.

I. SEC: 1 2 3 4 5 6 7 8 9.

II.A. PROVISIONING: 1 2 3 4 5.

B. FOOD PREP: 1 2 3 4 5 6 7 8.

C. NUTRITION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15.

D. SURVIVAL: 1 2 3 4 5 6 7.

III.A. CLOTHING: 1 2 3 4 5 6 7 8 9 10 11 12 13 14.

B. SPIRITUAL:1 2 3 4 5 6 7.

C. LUGGAGE: 1 2.

IV. HEALTH: A B C D E F G H I.

V. PG MOMS: A B C D E F G H I J K.

VI. BABY: A B C D E F G H I J.

VII. WITNESSING: A B C D E F G H I.

VIII. CHILDREN: A B C D E F G H I J K L M.

IX. LEGAL: A B C D E F G H.

X. SCHED: A B C D E F G H I J K.

XI. MISC: A B C D E.

XII. BLOBS: A B C D E.

III.A.13: CHANGES NEEDED

FURTHER COMMENTS, QUESTIONS‚ SUGGESTIONS, EXPLANATIONS, PLANS TO IMPROVE & HOW SOON, COMPLAINTS:

How did your Home rate on this Checklist?____ Very Good (Under 20 No's)____ Good (20–40)_____Fair (41–60)____Poor (61-80)___Bad (81-100)___Awful! (Over 100!)

These art the facts or estimates to the best of my knowledge, so help me God!—In Jesus' name, Amen.

Signature of Home Servant & Handmaiden

Signature of Typist___________________

Copyright (c) 1998 by The Family