Professional Documents
Culture Documents
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Make check payable to
To the Worshipful Master, Wardens, and Brethren of Cleveland Lodge No. 781
Member Fee $150.00
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.
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Print name below in full, as for example “John Quincy Adams” – If no middle name, list “none”
Address
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City, State, Zip
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His resides at his present address where he has lived since the ______ day of _________________,
_________ (year)
Address
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Marital Status: Married ___ Wife’s Name ____________________ Divorced _____ Widower ____
Single _____
Bro.
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Dated at Cleveland, OH on this _____ of ___________, __________
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