Form Gl-601 - Petition For The Degrees Of Freemasonry Page 2

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I hereby certify on my honor that all these answers are true and correct, and that I have read, understood, and agree with all the statements made on this
application form, and hereby agree that I will not petition any other body of Masonry for Degrees for a period of six months after receiving my Master
Mason Degree, or until I have passed a satisfactory examination in the catechism of the Master Mason Degree.
SIGN YOUR FULL NAME (in ink) ______________________________________________
(Type or print your full name) __________________________________________________________
Initiation Fee (First Degree) ................................................................................. $________________
to accompany this petition
Fellow Craft (Second Degree) .............................................................................. $________________
Master Mason (Third Degree) .............................................................................. $________________
Annual Dues ......................................................................................................... $________________
George Washington National Monument Association ........................................ $________________
$5.00 E.A.
Masonic Home Endowment Fund (Voluntary) .................................................... $________________
$7.30
RECOMMENDATIONS
We recommend the above petitioner as a candidate for the Degrees of Masonry, based upon our belief that he is of good moral character, temperate,
industrious.
(Must have two recommendations)
__________________________________________________________
{
__________________________________________________________
Signatures of Members of the Lodge to which the petition is directed:
REFERENCES
(NOTE: SHOULD BE DIFFERENT FROM ABOVE RECOMMENDATIONS)
Each petitioner is required to furnish in the space provided below, the name of three (3) persons (preferably Masons, local) as references that have known
him for a period of five years or more.
NAME
STREET ADDRESS
CITY/STATE/ZIP
(1.) ________________________
_________________________
______________________
(2.) ________________________
_________________________
______________________
(3.) ________________________
_________________________
______________________
TO BE COMPLETED AFTER THE INVESTIGATION
I acknowledge receipt of the original background investigation obtained by the Lodge this ______ day of _______________, _________ and
acknowledge that my social security number has been redacted.
Signed: __________________________________________________

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