To the Worshipful Master,
Officers and Members of

Lodge Name____________________________________Lodge No.________

Free and Accepted Masons of Pennsylvania

I, the undersigned, respectfully pray that I may be Initiated into the mysteries of Freemasonry and become a Member of your Worshipful Lodge.

I declare that I am free by birth, unbiased by the improper solicitation of friends, and uninfluenced by mercenary or other improper motives; that I am prompted solely by a favorable opinion conceived of the Institution, and a desire of knowledge; and that I freely and voluntarily offer myself as a Candidate. I further declare my belief in the existence of a Supreme Being; that I have never before Petitioned any regularly Constituted Masonic Lodge to be made a Mason and been rejected; and that, if my Petition is approved, I will conform to the Ancient Usages and Customs of the Fraternity.

Name in full

______________________________________________

(Give First and Middle Names in Full)

Age______

Date of Birth ____________

S.S.#_________________

Occupation

______________________________________________
(State specifically and in detail the character of the occupation)

Residence

______________________________________________

(Give Street and Number)

City _____________

State________

Zip___________

County _____________

Telephone_____________

Where I have continuously resided since_______________

My Former Residences were:

at___________________________________for_________

years, and

at___________________________________for_________

years.

Place of Birth

_______________________________________
(City) (State) (County)

Name of Employer

___________________________________________

Business of Employer

___________________________________________

Signature of Petitioner

___________________________________________

Date of Signature

___________________________________________

Are you a Senior DeMolay? yes ____ no_____

 

 

I recommend the Petitioner as worthy and certify that I have been personally acquainted with him immediately preceding this date.

________________________________________
Signature of member of this Lodge

Date ____________

I recommend the Petitioner as worthy and certify that I have been personally acquainted with him immediately preceding this date.

________________________________________
Signature of a Pennsylvania Mason

Date ____________

 

The Committee appointed on the within Petition of

________________________________________
Full Name of Petitioner

to make the necessary inquiries relative to his fitness for Initiation as a Freemason and for membership in this Lodge, hereby certifies that at least one of the undersigned has personally interviewed the Petitioner at his home, has read to him the Petition, and has inquired whether he subscribes to all the conditions thereof. The committee has made a diligent and careful inquiry as to all matters which pertain to the character and residence of the Petitioner and reports

_____in favor of

_____ not in favor of

the Prayer of his Petition being granted.

 

 

Witness our hands this__________________day of
_______________ A.D. ______, A.L.____________.

 

Committee

X____________________________________
Chairman

X____________________________________

X____________________________________


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