Petition For Degrees Form printable pdf download

MEMBER CODE ___________

_________________________ LODGE NO. ___________, A. F. & A. M.

___________________________, NORTH CAROLINA

PETITION FOR DEGREES

Dated ________________________ at __________________________________________________________, N. C.

Phones

Petition Status

Degrees

Read

__________________

EA ____________________

Residence (_____) _______________

Elected _________________

FC ____________________

Business (_____) _______________

Rejected ________________

MM ____________________

Mobile (_____) _______________

E-mail address ________________________________________________________________________________________________

TO THE MASTER, WARDENS, AND MEMBERS

I, ___________________________________________________________________________________, being a free man and of

Print your COMPLETE name First, middle, other middle, surname, suffix

full age of ______________ years, do acknowledge my belief in the existence of one ever-living and true God and do declare that,

unbiased by improper solicitation of friends, and uninfluenced by mercenary motives, I

Freely and voluntarily offer myself a candidate for the Mysteries of Masonry and am prompted by a favorable opinion conceived of

the institution. I have a desire for knowledge and a sincere wish to be of service to my fellow creatures. I am possessed of sufficient

means to enable me to meet the charges of initiation and the support of membership in the Craft without detriment to my family

or connections. I will cheerfully conform to all the ancient usages and established customs of the order and I am aware that Free-

masonry offers no pecuniary benefits to its members and am satisfied that I have been fully informed on the financial obligations I

shall incur as a member of the Lodge. I agree that all verbal or written communications made in connection with this petition, and

as to my character and qualification for admission into Freemasonry, shall be privileged.

Please answer the following questions completely.

Birth Date _______________________ Place ______________________________________________________________________________

[City or postal area, county, state, country]

Father’s Full Name __________________________________________________________________________________________________

[First, middle, other middle, surname, suffix]

Mother’s Maiden Name _______________________________________________________________________________________________

[First, middle, other middle, surname]

Wife’s Maiden Name ___________________________________________________ Birth Date __________________________________

[First, middle, other middle, surname]

Present Residence Address ____________________________________________________________________________________________

[Number, street, apt., city, state, zip-code]

Please list all previous addresses for the past FIVE YEARS:

From _____________ To ______________ At ______________________________________________________________________________

[Number, street, apt., city, state, zip-code]

_____________ To ______________ At ______________________________________________________________________________

[Number, street, apt., city, state, zip-code]

Current Mailing Address _____________________________________________________________________________________________

[Number, street, apt., city, state, zip-code]

Have you petitioned for degrees in Masonry before? “Yes/No” (Circle Your Answer) (If Yes, please provide particulars:)

Year

Lodge Name

Number

Located in

Action taken

______________________________________________________________________________________________________________________

Have you any physical disabilities? “Yes/No” (Circle Your Answer)

(If yes, please describe in detail.)

______________________________________________________________________________________________________________________

(over)

NC Form 17 (rev January 2011)

Petition For Degrees Form

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