MASONIC LAST RITES REQUEST FORM

Masonic Last Rites Request
Dear Brother:
Many times, we delay difficult decisions in our lives believing that our time on earth is not finite.
Unfortunately, this delay may result in decision making by others that we would have preferred to
make ourselves. In an effort to assure that your desires are adhered to, this form has been designed
to help prepare each of us for that time when we approach the East Gate of life and prepare to enter
that “undiscovered country,” that house not made with hands, eternal in the heavens. Completion of
this form is not required. It is merely being provided to you as a convenience, as an act of fraternal
friendship and love from your lodge brothers.
To the members of ______________________Lodge No. _______, at _________________, Iowa;
members of my immediate family, members of the clergy, and the proprietors of the funeral home.
Upon my death:
I would like to have a:
_____ Masonic Memorial Service conducted at the funeral home.
_____ Masonic Memorial Services conducted at my place of worship along with my
religious memorial rites, if possible.
_____ Masonic Graveside Services.
_____ No Masonic Service.
I would like to be remembered in my Masonic eulogy for having:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
I would like the following brothers to serve as pallbearers and/or honorary pallbearers, (if able and
willing) at my funeral.
Pallbearers
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
Honorary Pallbearers
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
My Masonic Apron can be found ______________________________________________
I would like to have my Masonic Apron:
_____ Placed upon my person.
_____ Draped upon my casket during the services.
_____ Buried with my remains.
_____ Given to _____________________________________________after the funeral.
©2008 Grand Lodge of Iowa
I would like my Masonic jewelry [ring(s), lapel pin(s), watch, etc]:
_____ Left on me and buried with me.
_____ Left on me during my last rites and then given to __________________________
_____ Given to my lodge for future presentation to ______________________________
_____ Given to my lodge for future presentation to a worthy brother of their choosing.
I would like to have my Masonic mementos [Past Master's Apron, books, awards, etc.]:
_____ Given to __________________________________________________________
_____ Donated to my lodge for them to use or dispose of as they see fit.
_____ Donated to Grand Lodge.
I would like to:
_____ Inform my local lodge that I have made a provision in my will for its future benefit.
_____ Inform the Grand Lodge that I have made a provision in my will for its future
benefit.
_____ Inform my local lodge that I have not made a provision in my will for its future
benefit but would like to discuss the possibility with its officers.
_____ Inform the Grand Lodge that I have not made a provision in my will for its future
benefit but would like to discuss this with the appropriate people.
I would like [special requests]:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Your completion and submission of this form is voluntary and is intended to provide comfort and
relief for your family and loved ones at a time when you will be unable to guide them. Should you
decide to complete and return this form to your lodge, please give careful thought to your responses
and make a copy to keep with your personal records. You may also want to give a copy to your local
funeral director and pastor. This form will be kept on file at the lodge and you may change or revoke it
at any time.
Signature: _________________________________________ Date: ___________________
Witness: (Optional)____________________________________ Date: ___________________
©2008 Grand Lodge of Iowa