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______
Contingent Beneficiary Name_________________________________________________
Mail
Application to:
Masonic Widow's Fund Association 3rd Masonic District
668 Twin Lakes Drive, DeFuniak Springs, Fl 32433
Phone # 850-892-2365 Cell Phone # 850-419-5732
