Petition No.

________________

Petition Fee $160.00

Petition For Degrees

To the W orshipful Master, W ardens and Brethren of

New Carlisle Lodge No. 100

Free and Accepted Masons of Ohio
The Petition of the Subscriber Respectfully Showeth:
That he has long entertained a favorable opinion of your Ancient Institution, and is desirous of being admitted
a member thereof, if found worthy. That he believes in the existence and perfection of God.
Have you ever before petitioned a Lodge of Free and Accepted Masons anywhere?
Yes____No____ If you have, state what Lodge, where situated and when petitioned.

His present residence is______________________________________________________________________

NUMBER

STREET

CITY

ZIP

Where he has lived since the ______day of _________________, _______.

Phone (

) - ______ - ______

Email _______________________________________________________

He was born at __________________________________ on the _____day of ________________, ________

His occupation is _______________________________ Place of business_____________________________
Dated this _____ day of __________________,________
Recommended by 2 New Carlisle Lodge Members

Signed:_______________________________________
(Sign with Full M iddle Name initials not permitted)

Bro.____________________________________
_____________________________________________
Bro.____________________________________

PRINT NAME IN FULL ON THIS LINE

Make check payable to: New Carlisle Lodge No. 100 and mail with petition to:
New Carlisle Lodge No. 100, Jay Maxwell, Secretary, 7021 Creekside Cir, Fairborn Ohio 45324

QUESTIONS
To be answered by Petitioner on
Night of Initiation
1. Do you declare upon your honor that you have
never made application to any Lodge of Free &
Accepted Masons?
Answer_______________________

2. Do you believe in the ever-living God as

revealed in the Holy Bible, and that it is your duty
to pay Him the reverence due from the creature to
the Creator?
Answer_______________________
3. Do you declare upon your honor, that, unbiased
by friends and uninfluenced by mercenary
motives, you freely and voluntarily offer yourself
a candidate for the mysteries of Freemasonry?
Answer_______________________

4. Do you declare upon your honor, that you are

prompted to solicit the privileges of Freemasonry
by a favorable opinion conceived of the
institution, a desire for knowledge, and a sincere
wish of being serviceable to your fellowcreatures?
Answer_______________________

PETITION FOR DEGREES

E.A. DEGREE

Name ____________________________

Initiated_________________________

Address __________________________

By_____________________________

City _____________________________

Lecture by_______________________

Zip ______________________________

Exam.__________________________

Phone: ___________________________

By_____________________________

Email: ___________________________

F.C. DEGREE
Fee Enclosed $____________________
COM M ITTEE

Passed__________________________

_________________________________

By_____________________________

_________________________________

Lecture by_______________________

_________________________________

Exam.__________________________

Received___________________, 20____

By_____________________________

Committee Notified__________, 20____

5. Do you declare upon your honor, that you will
cheerfully conform to all the ancient usages and
established customs of the Fraternity?
Answer_______________________

Signed_________________________________
Candidate

Elected____________________, 20____
Rejected___________________, 20____
REPORT OF
INVESTIGATING COM M ITTEE
*____ Favorable___________________

M.M. DEGREE
Raised__________________________
By_____________________________
Lecture by_______________________
Exam.__________________________

Attested:

*____ Favorable___________________
______________________________________
Steward

*____ Favorable___________________
*If the report is Unfavorable write Un
before the word Favorable.

By_____________________________