Masonic Widow's Fund Association, 3rd. Masonic District
Your Lodge Name.__________________________________ Number. _______
Application No. ______ Approved: _______________
Your Name:______________________________________________ Date of Birth______________
Address ______________________________________City_______________State____Zip______
Signature______________________________________Date_________ S.S.#________________
Make the application for membership into the Masonic Widow's Fund Association of the 3rd. Masonic District of Florida,
and contribute the sum of $10.00 as membership fee. I agree to comply with the By-Laws and regulations governing this association
by donating $5.00 to replenish the Widow's Fund upon the death of 4 members of the association.
Primary Beneficiary name______________________________________________________
Address __________________________________City_______________State____Zip______
P.O. BOX 603
