| To the Worshipful Master, Wardens and Brethren of: |
| Free and Accepted Masons in the State of New York. |
|
The undersigned, not being influenced by improper solicitation, mercenary, selfish or other unworthy motives, and prompted by a favorable opinion of and a desire for knowledge of, The Ancient and Honorable Institution of Free and Accepted Masons, freely and voluntarily makes application to be a candidate to receive the Degrees of Freemasonry, respectfully petitions the above named Lodge for initiation and advancement, promising a cheerful conformity to the ancient usages and established customs of the Order, and upon his honor has answered the following questions truthfully and in his own handwriting and no other: |
| 1. | What is your full name? | . |
| 2. | Where were you born? | . |
| 3. | What was the month, day and year of your birth? | . |
| 4. | Where have you resided for the twelve months last past? | . |
| 5. | What are your home and business phone numbers? | . |
| 6. | Do you believe in the existence of one ever living and true God? | . |
| 7. | Do you believe in the immortality of the soul? | . |
| 8. | Have you ever been convicted of a crime, irrespective of where sentence has been suspended? If so, state facts concisely: | . |
| 9. | Have you ever presented a petition to a Masonic Lodge either in this state or elsewhere? If so, when and to what Lodge? | . |
| 10. | Have you ever been rejected by a Masonic Lodge, either in this State or elsewhere? If so, when and by what Lodge? | . |
| 11. | Where have you resided for the 10 years last past? If in more than one place, state the years in each place: | . |
| 12. | What has been your business occupation for the 10 years last past? State explicitly, specifying particular years and where conducted: | . |
| 13. | Have you read the foregoing questions? | . |
| 14. | Are all of the foregoing answers in your own handwriting? | . |
| 15. | Do you, upon your honor, declare all of the answers to be true? | . |
| Signature of Petitioner: |
| Presented by Brother: | Signature of Proposer: |
of the above Lodge, who hereby certifies that he is well acquainted with the petitioner, that he has read the answers to the questions contained in the petition and believes them to be true and that the petitioner is of good character and comes under the tongue of good report. |
| Name: | Address: | Phone Number: | |||
| Name: | Address: | Phone Number: | |||
| Name: | Address: | Phone Number: |
| Please print and fill in by hand |