Make your own free website on Tripod.com

Petition for Scottish Rite Degrees
Ancient and Accepted Scottish Rite of Free Masonary, S.J.
Valley of Covington, Orient of Kentucky

Date -- mm/dd/yy

    I am a Master Mason in Lodge No. F. & A.M.,

located in State of

First Name Middle Initial Last Name
(NO INITIALS – IF ONLY TWO NAMES OR INITIALS, SO STATE)

Residence (Street Address)
                                       City State Zip

Home Phone Number Business Phone Number

Wife's Name Your E-Mail Address

Firm Name Type of Business
                                                                                                                                                                                            (State Specifically)
Your Position Within Firm Social Security #

Birth - Month Day Year Age City State

I support “The inculcation of Patriotism, respect for Law and Order and undying Loyality to the principles of civil and religious Liberty and the entire separation of Church and State as set forth in the Constitution of the United States of America.”

 I have never held or expressed opinions contrary to the foregoing or been affiliated with any organization which has. The statements in this petition are on my honor as a Mason.

I have lived in Kentucky years and have never previously applied for any of the Scottish Rite Degrees and I now respectfully petition to receive the degrees from the to inclusive promising always to bear true Faith and Allegiance to the Supreme Council of the 33rd and last degree for the Southern Jurisdiction of the United States.

__________________________________________________
APPLICANT MUST SIGN NAME IN FULL (NO INITIALS)

Those recommending     Recommended By:
    must be in good
 standing & members    
Recommended By:
    of the Valley of 
       Covington

Note:  A minimum fee of $75.00 must accompany petition.


FIRST LINE SIGNER PLEASE CHECK ONE OF THE FOLLOWING:

DUES ___________________  COAT ___________________  LIFE ________________________

(Office use only)

Petition Presented Date: __________  Date Elected: __________    Date Notified: __________   Cash   Check

Amount of Fees Paid: $ __________ Balance of Fees Due $ ___________ Amount of Dues Paid $ ___________


Copyright © 2002 [Covington Scottish Rite]. All rights reserved.
Revised: January 05, 2003