Provided always, that the said above-named brethren and their successors do pay, and cause to be paid, due respect and strict obedience to the Most Worshipful Grand Lodge of Ancient Freemasons of . . . . . . . . . . . aforesaid, and to the rules, regulations, and edicts thereof: otherwise, this Warrant of Constitution to be of no force nor virtue.
Given in open Grand Lodge, and under the hands of our Grand officers, and the seal of our Grand Lodge, at . . . . . . . ., this . . . . day of . . . . ., in the year of Light 58. . .
| Q . . . . R . . . . , | U . . . . V . . . . , | |
| Grand Master. | Senior Grand Warden. | |
| S. . . . T . . . . , | [l.s.] | W . . . . X . . . . , |
| Deputy Grand Master. | Junior Grand Warden. | |
| Y . . . . Z . . . ., Grand Secretary. | ||
IV. PETITION FOR INITIATION.
To the Worshipful Master, Wardens and Members . . . . . . of Lodge, No . . . .
Gentlemen:
Being prompted by a favorable opinion conceived of the Institution, unbiased by the improper solicitation of friends and uninfluenced by mercenary motives, I voluntarily offer myself a candidate for the mysteries of Freemasonry to be conferred it your Lodge.
If elected, I promise cheerfully to conform to all the ancient usages and established customs of the fraternity.
I am by occupation a . . . . . . ., aged . . . . years, and without any mental or physical defects which, as I am informed, would preclude my initiation.
