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Knights of Pythias Membership Card Application

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Filing Form No. 2

This card was deposited in

______________________________Lodge No.________

Located at______________________________________ Domain of ______________________________________ On the______day of_______________________ 19______ Suspended_______________________________19______ Expelled_________________________________ 19______ Reinstated_______________________________ 19______ Transferred_______________________________ 19_______ Withdrawn________________________________ 19_______

Filing Form No. 3

This card was deposited in

______________________________Lodge No.________

Located at______________________________________ Domain of ______________________________________ On the______day of_______________________19______ Suspended_______________________________19______ Expelled__________________________________19______ Reinstrated________________________________19______ Transferred________________________________19_______ Withdrawn_________________________________19_______

Filing Form No. 4

This card was deposited in ______________________________Lodge No.________

Located at______________________________________ Domain of ______________________________________ On the______day of_______________________19______ Suspended_______________________________19______ Expelled__________________________________19______ Reinstrated________________________________19______ Transferred________________________________19_______ Withdrawn_________________________________19_______