Ancient Order of Hibernians in America, Inc. |
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My name is _________________________________Occupation___________________________________
Age_________ Born on___________ Are you Irish by birth or descent? Yes _____ No _______________ What was your mother’s maiden name? _______________________________________________________ Are you a Roman Catholic? ________ Have you complied with your religious duties? __________________ Name of you 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 # (B) _______________________________ Were you ever previously a member of the A.O.H., if so, in what City or Town and State? _______________ ________________________________________________________________________________________ What was your previous membership number, if available? _________________________________________ What was the reason and date of your withdrawal? _________________________________________________
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PROPOSER'S CERTIFICATE: I herby 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: ______________________________________________ would respectfully report that we have investigated the qualifications of said applicant for membership in the Order and recomment him for said membership. Signature __________________________________ |
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 ________ Signed ________________________________ FINANCIAL SECRETARY: I hereby certify that the initiation fee of $__________ has been paid on the _______ day of __________ 20 _____ Signed _______________________________________ AOH National office: 31 Logan St., Auburn, NY 13021 Phone (315) 252-3895 - FAX (315) 252-6966 |