ANCIENT
AND ACCEPTED SCOTTISH RITE OF FREEMASONRY
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___________________
CANDIDATE PLEASE ANSWER
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___________