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:_______________
(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
(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) 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)
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)
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:_______
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
VII. LIT SHINERS
CATACOMB DISCIPLE SHINERS
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
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
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:____________________
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: ____________
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.)
XIII.b. COMMENTS, SUGGESTION, etc. (This space is for you!):
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
No. of Fish Given:
Light 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
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:
Total No. Witnessed to
Total No. Rec'd. Jesus
TYPES OF FISH FFed:
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: ________
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
NAMES OF TOP 3 FF LOVERS OF THE MONTH (SEX)
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___________________