Instructions for Notifying Masonic Organizations of My Death

TO MY SURVIVORS: Upon my death, please notify my Masonic Lodge and the following Masonic organizations. (My Lodge can be contacted by calling the Grand Secretary's office at the Grand Lodge of Georgia, F. & A. M., (478) 742-1475. That office will provide you with the name and telephone number of the current Lodge Secretary. The Grand Secretary can also provide a copy of my Masonic record indicating my eligibility.)

q  Lodge Name: No:__________________________________________________________________________________

q  Lodge City: Lodge State: ____________________________________________________________________________  
Other Masonic organizations to which I may belong:

q  Scottish Rite — Valley of_____________________________________________________________________________

q  York Rite_________________________________________________________________________________________

q  Shrine — Temple__________________________________________________________________________________

q  Order of Eastern Star_______________________________________________________________________________

q  Amaranth________________________________________________________________________________________

q  Red Cross of Constantine____________________________________________________________________________

q  Other____________________________________________________________________________________________

q  Other____________________________________________________________________________________________

q  Other____________________________________________________________________________________________

q  Other____________________________________________________________________________________________ 

I request the following:

q  Yes, I want Masonic Services or

q  No, I do not want Masonic Services

My Masonic apron may be found at____________________________________________________________________

(Note: My apron should accompany my body to cremation or burial.)

My Name____________________________________________________________________________________________

Address_____________________________________________________________________________________________

City State Zip_________________________________________________________________________________________

(Signed)_________________________________________________ Date__________________________

(Note: This form must be signed and dated. Give a copy of this page to your Lodge Secretary. Use the back of this page to write your family any personal and specific directions that you might have such as the disposal of your Masonic paraphernalia.)

Created by the Georgia Fifth Masonic District Convention and approved by the Educational and Historical Commission, May 2016.