Southern Jurisdiction, Valley of Yankton, South Dakota

I am a Master Mason in good standing, eligible to petition for the Scottish Rite Degrees, (if a member of a South Dakota Lodge, I have proved up on the Master Mason Degree) reside as shown below and am a qualified voter of such state.  I have never applied for any of the Scottish Rite Degrees and I now respectfully petition to receive the degrees from the 4th to the 32nd inclusive, promising always to bear  true faith and allegiance to the Supreme Council of the Thirty-third Degree for the Southern Jurisdiction of the United States.

The Supreme Council announces as fundamental principles the following:
"The inculcation of patriotism, respect for law and order and undying loyalty to the principles of civil and religious liberty and the entire separation of church and state as set forth in the constitution of the United States."
Do you approve wholeheartedly of these principles?________________________________________________________

Have you ever held or expressed opinions contrary to the foregoing or been affiliated with any organization that has?________   If you answer in the affirmative, give particulars: 

Recommended by:                                 Usual Signature of Applicant
1._______________________              _______________________
2._______________________             Date___________________


First Name____________________ Middle Name_____________________ Last Name_____________________________

Mailing Address___________________Street or Avenue___________________________Rural Route Box No.__________

City______________________________ State_____________________ Zip Code______________________

Date of Birth________________(month/day/year) Place of Birth_______________________________________

AreaCode______ PhoneNumber____________________

(Give detailed information about occupation, if merchant, what kind of merchant, what kind of engineer, salesman, plumber, manager, etc.)

Occupation:____________ If retired, occupation before retiring:_____________________________________

Employer (note if self employed)______________________________________________________________

Blue-Lodge Name________________________ No.______ City_____________________ State___________

FEES: Initiation fees for the degrees from 4th to 32nd are $175 or $100 for those under age 31. A deposit of $50 must accompany petition. Flexible payment plans are available for the balance. Please complete this petition and mail check and Petition to: Yankton Scottish Rite, 333 Cedar St., Yankton, SD 57078, Lodge phone number 665-2414. Any Master Mason may apply for the degrees for the Scottish Rite provided he is in good standing , has proved up to the Master Mason degree, and is recommended by two Members of the Rite