Form SBM-LM-1 "Labor Organization Information Report" - Missouri

What Is Form SBM-LM-1?

This is a legal form that was released by the Missouri Department of Labor and Industrial Relations - a government authority operating within Missouri. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on September 1, 2018;
  • The latest edition provided by the Missouri Department of Labor and Industrial Relations;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SBM-LM-1 by clicking the link below or browse more documents and templates provided by the Missouri Department of Labor and Industrial Relations.

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Download Form SBM-LM-1 "Labor Organization Information Report" - Missouri

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For Official Use Only
MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
STATE BOARD OF MEDIATION
P.O. Box 2071
Jefferson City, MO 65102-2071
SBM-LM-1
LABOR ORGANIZATION INFORMATION REPORT
This report is mandatory under RSMo. 105.535, as amended.
Failure to comply may result in criminal prosecution, fines, or civil penalties as provided by RSMo. 105.555 (2018).
READ THE INSTRUCTIONS CAREFULLY BEFORE PREPARING THIS REPORT
Identification Items (To be completed by all filers)
1. File Number:
2. What is your organization’s fiscal year ending date?
3. Is this the first Form SBM-LM-1 your organization has filed with Missouri?
Yes, this is an INITIAL FORM SBM-LM-1
No, this is an AMENDED FORM SBM-LM-1
(Complete Items 2 through 20)
(Complete Items 1 through 9, 16, 18, 19, and 20)
4. Affiliation or Organization Name
5. Designation (Local, Lodge, etc.)
6. Designation Number
7. Unit Name (if any)
Prefix
Number
Suffix
8. Mailing Address:
9. Any other address where records are necessary to verify this
report are kept:
Name
Name:
Title:
Title:
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.)
19. Signed
20. Signed
/S/________________________________________________
/S/________________________________________________
President
Secretary
(if other title, see instructions)
(if other title, see instructions)
On_______________ Phone Number____________________
On_______________ Phone Number____________________
Missouri Department of Labor and Industrial Relations is an equal opportunity employer/program. TDD/TTY: 800-735-2966 Relay Missouri: 711
SBM-LM-1 (09-18) AI
For Official Use Only
MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
STATE BOARD OF MEDIATION
P.O. Box 2071
Jefferson City, MO 65102-2071
SBM-LM-1
LABOR ORGANIZATION INFORMATION REPORT
This report is mandatory under RSMo. 105.535, as amended.
Failure to comply may result in criminal prosecution, fines, or civil penalties as provided by RSMo. 105.555 (2018).
READ THE INSTRUCTIONS CAREFULLY BEFORE PREPARING THIS REPORT
Identification Items (To be completed by all filers)
1. File Number:
2. What is your organization’s fiscal year ending date?
3. Is this the first Form SBM-LM-1 your organization has filed with Missouri?
Yes, this is an INITIAL FORM SBM-LM-1
No, this is an AMENDED FORM SBM-LM-1
(Complete Items 2 through 20)
(Complete Items 1 through 9, 16, 18, 19, and 20)
4. Affiliation or Organization Name
5. Designation (Local, Lodge, etc.)
6. Designation Number
7. Unit Name (if any)
Prefix
Number
Suffix
8. Mailing Address:
9. Any other address where records are necessary to verify this
report are kept:
Name
Name:
Title:
Title:
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.)
19. Signed
20. Signed
/S/________________________________________________
/S/________________________________________________
President
Secretary
(if other title, see instructions)
(if other title, see instructions)
On_______________ Phone Number____________________
On_______________ Phone Number____________________
Missouri Department of Labor and Industrial Relations is an equal opportunity employer/program. TDD/TTY: 800-735-2966 Relay Missouri: 711
SBM-LM-1 (09-18) AI
Name of Labor Organization:
File Number:
Identification Items (To be completed by all filers)
10. Where is your organization chartered to operate?
11. When is your organization’s next
regular election of officers?
City:
County:
State:
Month:
Year:
12. Is your organization:
A Local, Lodge, Branch, etc.
An Intermediate Body (a conference, general committee, joint board, system board, joint council, district, etc.)
A National or International
13. List the names and titles of all your organization’s officers:
Name:
Title:
14. What are your organization’s rate of dues and fees? (Enter a minimum and maximum if more than one rate applies for any line.)
Per (month, year, etc.)
Minimum
Maximum
a. Regular Dues/Fees
$
b. Working Dues
$
c. Initiation Fees
$
d. Transfer Fees
$
e. Work Permits
$
15. A copy 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:
SBM-LM-1-2 (09-18) AI
Name of Labor Organization:
File Number:
16. 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 17 or on an attached page.
Page, Section, and/or Paragraph Number
Described
Practice or Procedure
of Constitution and Bylaws
in Item 17
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
g.1. Selecting officers and stewards and selecting any
representatives to other bodies composed of labor
organizations’ representatives
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)
h. Disciplining or removing officers or agents for breaches
of their trust
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. Issuing work permits
17. Additional Information (To be completed by all filers, as necessary)
SBM-LM-1-3 (09-18) AI
Name of Labor Organization:
File Number:
18. Subunit Information (To be completed by all filers)
Are additional pages needed for Sub Unit Information
Yes
No
Name of Subunit:
SBM Case Number:
Is there a contract involved?
Contract Ending Date (Month-Day-Year):
Original SBM Certification Date (Month-Day-Year):
Voluntary
Yes
No
Name of Subunit:
SBM Case Number:
Is there a contract involved?
Contract Ending Date (Month-Day-Year):
Original SBM Certification Date (Month-Day-Year):
Voluntary
Yes
No
Name of Subunit:
SBM Case Number:
Is there a contract involved?
Contract Ending Date (Month-Day-Year):
Original SBM Certification Date (Month-Day-Year):
Voluntary
Yes
No
Name of Subunit:
SBM Case Number:
Is there a contract involved?
Contract Ending Date (Month-Day-Year):
Original SBM Certification Date (Month-Day-Year):
Voluntary
Yes
No
Name of Subunit:
SBM Case Number:
Is there a contract involved?
Contract Ending Date (Month-Day-Year):
Original SBM Certification Date (Month-Day-Year):
Voluntary
Yes
No
Name of Subunit:
SBM Case Number:
Is there a contract involved?
Contract Ending Date (Month-Day-Year):
Original SBM Certification Date (Month-Day-Year):
Voluntary
Yes
No
Name of Subunit:
SBM Case Number:
Is there a contract involved?
Contract Ending Date (Month-Day-Year):
Original SBM Certification Date (Month-Day-Year):
Voluntary
Yes
No
Name of Subunit:
SBM Case Number:
Is there a contract involved?
Contract Ending Date (Month-Day-Year):
Original SBM Certification Date (Month-Day-Year):
Voluntary
Yes
No
Name of Subunit:
SBM Case Number:
Is there a contract involved?
Contract Ending Date (Month-Day-Year):
Original SBM Certification Date (Month-Day-Year):
Voluntary
Yes
No
SBM-LM-1-4 (09-18) AI
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