Petition for the Degrees In Freemasonry

FEES FOR DEGREES````Application Fee  $___________Date _______________

*E.A. Degree $________F.C. Degree $________M.M. Degree $________Total $__________
*(Fee Must Accompany Petition)
To the Worshipful Master, Wardens and Brethren
Of ____________________________________________ Lodge No. __________________________
I, the undersigned, respectfully state, that, unbiased by friends and uninfluenced by mercenary motives, I freely
and voluntarily offer myself as a candidate for the Degrees of Masonry; that I am prompted to solicit this
privilege by a favorable opinion conceived of the institution, a desire for knowledge and a sincere wish of being
serviceable to my fellow creatures and should this petition be granted, I will cheerfully conform to all the ancient
established usages and customs of the Fraternity.

Full Name _____________________________________________________________ Age _________
(Print)   First Middle Surname
I was born at _________________________________ on the ______ day of ________________  (Month Year)

I reside at ______________________________________________________________________________
(No. Street City-Town-Village State Zip Code)

My occupation is ___________________________________.

I am employed by ________________________________________ Soc. Sec. # ____________________

My telephone numbers are: Residence _____________________ Business ________________________

I have resided at the address given for the ______ years last past. Spouse’s Name ___________________

For the five years last past I resided at the following addresses and places _________________________

Have you ever before petitioned any Lodge for the Masonic Degrees? ____ If so, give the name, number and
location of the Lodge with full explanation ____________________________________________________

I am a citizen of __________________________ I have _________ been convicted of a criminal offense.

Names and addresses of two business acquaintances or friends

_____________________________________________     ____________________________________

_____________________________________________     ____________________________________

All of the statements I have made in this petition are true and correct to the best of my knowledge.

Signature ____________________________________________

Print Signature ________________________________________

We the undersigned, are personally acquainted with the above named petitioner, and from our confidence in
his integrity do cheerfully recommend him as a proper candidate for the Degrees in Masonry.

Signature ____________________________ Lodge ______________________ No. _______

Print Signature ______________________________.          Date _______________________

Signature ____________________________ Lodge ______________________ No. _______

Print Signature ______________________________.  Date  ______________________