Form 19 - Report Of Committee Of Investigation

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_________________________________________LODGE NO. ______________________, AF.&A.M.
______________________________________________, N.C.
REPORT OF COMMITTEE OF INVESTIGATION
Dated at __________________ , N. C.
_________________________, 20 _____
Brethren:
In re: _________________________
You have been appointed a Committee of Investigation on the ______________________ of
(Note 1)
the subject. His date of birth is ________________, and his place of birth is _____________
His occupation is _________________, and he is employed by _______________________
whose address is _______________________He resides at _____________________________________________
and says that he has resided there for __________ He says that he has ___________ physical defects. That he was
_________________discharged from the Armed Forces of the U. S. A.
( Note 6 )
His Home Phone No ___________
Work Phone ____________
Cell_________
He gives as references:
Name
Address
Occupation
Telephone
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
He is recommended by Brothers_______________________ and _______________________________ of this
lodge.
READ CAREFULLY THE INSTRUCTIONS ON THE BACK OF THIS PAGE.
When you have satisfied yourself by personal investigation and diligent inquiry as to his residential, moral, physical,
and mental qualifications, and as to his physical condition and other characteristics and are ready to make your report,
either favorable or unfavorable, please use form below and file with the Secretary on or before the stated
communication to be held _________________________________________________________ ,20_____
We, the Committee of Investigation on the_____________________ as indicated above, for ______________
(Note 1)
______________ in the lodge, beg leave to report that, having made careful investigation and diligent inquiry
(Note 2)
as directed in the above letter, WE HAVE CONFERRED and we recommend that _______________________
favorable action be had thereon. We further report that each member of the committee has complied with the
instructions on the back of this page, and we understand that the answers to the questions on the back hereof
comprise, and are, a part of this report. _______________________________, 20 ___
Chairman
____________________________________________
____________________________________________
N. C. Official Form 19

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