MASONIC LAST RITES REQUEST FORM

Completion and submission of the form is not required. It is intended to provide comfort and relief for your family and loved ones at a time when you will be unavailable to guide them.  Should you decide to complete this form, please give careful thought to your responses.  Make a copy for your personal records and any other individual or group you deem necessary. Give or send the completed form to your Lodge for their safekeeping. In the event of your death, your Lodge will then be able to assist your family with the requested arrangements.

Completing this form is not required in any way, it is merely provided for your convenience as an act of brotherly love and fraternal friendship by _____________ Lodge #___.

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To the Brothers of ________________ Lodge No. ____, members of my immediate family, members of the clergy and the proprietors of the funeral home, upon my death I would like to have:

_____  Masonic Funeral Services conducted at the funeral home.

_____  Masonic Funeral Services conducted at my place of worship along with my religious memorial rites, if possible.

_____  Masonic Funeral Services conducted at my lodge with my religious memorial rites, if possible.

_____  Masonic graveside Services.

_____  No Masonic Services.

I would like to be remembered in my Masonic eulogy for having:

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I would like the following Brothers to serve as pallbearers at my funeral (if able and willing):

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Besides being a member of my Lodge, I am also member of the following Masonic Lodges or appendant organizations:

Organization:                                                          Location:                                                               

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I request:

_____  My Masonic Apron be placed on my person or laid within the casket and buried with me.

_____  My Masonic Apron be given to my family after the service.

_____  Other symbolic Masonic items (Aprons, Fez, Sword, etc.) be placed in the casket with me.

_____  Other symbolic Masonic items be left on my body during the service and then given to:

Other Masonic items (pins, jewelry, books and literature, etc.) should be given to:

I would like memorials given at my funeral sent to:

I request that my Lodge and or appropriate appendant body be informed that I have made provision for future benefit for it, as discussed with family or noted in my personal and or legal papers or noted below.

I would like the following special requests and or provisions:

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Signature:                                                                                                     Date:                               

Witness:                                                                                                       Date:                               

My Lodge can be reached by calling or contacting the following individuals: