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136 Residence............

Recommended by................ ................

(The Petition must be accompanied by a Dimit from the Chapter of which the Petitioner was last a member, or its absence satisfactorily explained.)

''That, ................., whose name appears in the margin of this instrument, was received into............Chapter, No......., of 19.... And that having paid all Dues, and being free from all charges, ...he is at .... own request lawfully dismissed from Membership therein.'' ''Given under my hand and the Seal of the Chapter, this......day of........,19... ....................Secretary.''