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 present or former member of 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.
____________________________________________________ Date ____________
Signature of a Pennsylvania Mason  
____________________________________________________  
Print Name  
____________________________________________________  
Address                             City,State Zip  
____________________________________________________  
Telephone  
A Member of ________________________________Lodge, No.__________,
Name of Lodge  
meeting at____________________________________,Pennsylvania.
Location  
   

 

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____________________________________
 
Initiation Fee$___________________
Amount Due with Petition$___________________
Balance Due prior to EA Degree $___________________
Annual Dues$___________________
(prorated monthly, following EA Degree)
Back