ANCIENT AND ACCEPTED SCOTTISH RITE OF FREEMASONRY

SOUTHERN JURISDICTION OF THE UNITED STATES

VALLEY OF DOTHAN, ORIENT OF ALABAMA

____________________________  20 _______________

Petition presented ________________________ Elected _____________________

TO THE OFFICERS AND MEMBERS OF

DOTHAN LODGE OF PERFECTION

DOTHAN CHAPTER OF ROSE CROIX

DOTHAN COUNCIL OF KADOSH

DOTHAN CONISISTARY

Ancient and Accepted Rite of Freemasonry, Dothan, AL.:

            The undersigned, a Master Mason in good standing, a resident of Alabama  for _________ years last past, hereby respectfully petitions to receive the degrees from the FOURTH through the THIRTY-SECOND, promising always to bear true   faith and allegiance to the Supreme Council of the Thirty-third Degree of the Southern Jurisdiction of the United States.

PERSONAL HISTORY

FULL NAME (NO INITIALS) ____________________________________________________________________________________

                                                                                                                (Print or Type)

                                                                                                                                SOCIAL SECURITY NUMBER ________________________

I WAS BORN IN (OR NEAR) THE CITY OF ________________________________County of ______________________________

State of ______________________________________on the ______________day of __________________ in year _______________

I RESIDE AT ____________________________________________________________________________ (Street or Avenue), in the

City of _______________________________________________County of ___________________ Res. Phone ___________________

State of ______________________________________________Zip Code ____________________ Bus. Phone ___________________

MY VOCATION IS (State Specifically) _____________________________________________________________________________

EMPLOYED BY _____________________________________________________________________________ Years _____________

BUSINESS ADDRESS _____________________________________________________ City ______________________State _______

                I desire to receive my mail at the following address:

Mailing Address _______________________________________ City _____________________State _______ Zip Code ___________

WHAT IS YOU CHURCH AFFILIATION? _________________________________________________________________________

FINANCIAL

                Make ALL CHECKS payable to DOTHAN LODGE OF PERFECTION and send to SCOTTISH RITE BODIES                     Office of the Secretary, P. O. Box 1074, Dothan, Alabama 36302.

I WOULD LIKE TO TAKE AN ACTIVE PART IN SCOTTISH RITE: ______DEGREE TEAM _______ SUPPORT WORKER

_______ MEMBERSHIP, ETC. ____BLUE LODGE 3^RDº TEAM _____ AMERICANISUM AND EDUCTION PROGRAM.

                                                                                                                                                                                                                                (OVER)