Ancient Order of Hibernians in America, Inc.
I hereby apply for admission into the Ancient Order of
Hibernians in America, Inc., and agree that my reception and continuance
would respectfully report that we have investigated the
qualifications of said applicant for membership in the Order and recommend
Signature_____________________________________________________________________ Signature .___________________________________________________________
Signature______________________________________________________________________
in said Order shall depend on the truthfulness of my
answers to the questions which are hereto attached, which answers are made
by me for the purpose of gaining admittance to the Order.
Please type or print clearly
My name is ________________________________ Occupation
___________________________
Age _______ Born on . Are you Irish by birth or descent?
Yes __ No __
What was your motherís maiden name? ______________________________________________
Are you a Roman Catholic? _________ Have you completed
your religious duties? ___________
Name of your Parish or Church _____________________________________________________
Do you belong to any society to which the Catholic Church
is opposed? _____________________
Your Residence: _________________________________________________________________
City: ___________________________________ State: ______________
Zip Code: _________
Business Address: ________________________________________________________________
Phone # (H) ________________________ Business # ___________________________________
email ________________________________________
Were you previously a member of the A.O.H., if so, in
what City, Town, and State? .
.______________________________________________________________________________
What was your previous membership number, if available?
._______________________________
What was the reason and date of your withdrawal? .______________________________________
the above questions are true.
Signature: . _____________________________________________________________
Dated this _____________day of 20______________
PROPOSER'S CERTIFICATE:
I hereby certify on my honor as a member of the Ancient
Order of Hibernians, Inc., that I am acquainted with the above applicant
I know him to be a practical Catholic, and one worthy
in every way to become a member of this Order
Signature .________________________________________________________________
STANDING COMMITTEE:
Your committee to whom was referred the application of:
.
____________________________________________________________________________
him for said membership.
PRESIDENT'S CERTIFICATE:
I hereby certify that this application has been read
to me at
a regular meeting and that the applicant has been elected
by
the membership of this division on the
day of _____________ 20 _______
FINANCIAL SECRETARY:
I hereby certify that the initiation fee of $ _______has
been paid on the _______day of___ 20______
Dooley Division Finacial Secretary:
Phone (804) 360-2969
Patrick Naughton, 12400 Perrywinkle Road, Glen Allen, VA 23059-5319
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