Petition For The Degrees-Missouri A.F. & A.M.: This Petition Must Be Accompanied by A Fee of $
Petition For The Degrees-Missouri A.F. & A.M.: This Petition Must Be Accompanied by A Fee of $
Petition For The Degrees-Missouri A.F. & A.M.: This Petition Must Be Accompanied by A Fee of $
3. RESIDENCE ADDRESS:_____________________________________________________________________
(Street) (City) (State) (Zip Code)
BUSINESS ADDRESS:_______________________________________________________________________
(Street) (City) (State) (Zip Code)
4. PRESENT OCCUPATION:________________________EMPLOYER:_______________________________
5. OCCUPATION FOR THE PAST TEN YEARS: Give name, nature and location of business (include street address)
MOST RECENT FIRST.
YEARS NAME NATURE LOCATION
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
6. ARE YOU, OR WERE YOU, A MEMBER OF THE ARMED FORCES? Yes No
7. RESIDENCE FOR PAST TEN YEARS: If in more than one place, state particular years in each place with detailed information
during last year MOST RECENT FIRST.
It is required that the petitioner must reside within the jurisdiction of the Lodge for the past six months.
YEARS CITY STATE
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
8. Have you petitioned any Masonic Lodge in Missouri or elsewhere? YES____ NO____
If the answer is YES, state when and where you did petition a Lodge and what the result was.
____________________________________________________________________________________
9. Has an indictment, complaint, or information ever been made, returned, or issued against you, or have you ever
been charged with, or convicted of, any crime, whether a misdemeanor or felony? YES____ NO____
If yes, please explain: _________________________________________________________________________
___________________________________________________________________________________________
(over)
SIGNATURE______________________________________________________DATED_________________
E-MAIL________________________________________CELL PHONE____________________________________
The foregoing applicant must be recommended by two MISSOURI MASTER MASONS, of which,
one must hold membership in this Lodge
________________________________________________________________________
Signature Lodge Name/No.
Two references to be supplied by applicant. They are not required to be Freemasons, but should be well-acquainted with him.
REFERS TO
_________________________________________________________________
_________________________________________________________________
_____________________
_
} Residence Address and Telephone Number
_________________________________________________________________
Business Address and Telephone Number (if applicable)