2021Bylaws

Form #8

CERTIFICATE OF DEMIT

Whereas ,

a Noble of the Order initiated a member

of

Shriners on

(date) and last a Member of

Shriners located at , under a Charter from Shriners International, has regularly withdrawn from said temple, and conformed to its bylaws, therefore he is hereby granted this certificate that he is in good standing, free from charges and free from indebtedness, assessments or voluntary obligations to this temple.

■ Check this box if Noble is the holder of a Permanent Contributing Membership and is exempt from paying Hospital assessment. (name of temple through Shriners which PCM was purchased).

(date PCM was purchased).

Date Remarks: _ ______________________________________

■ Check this box if Noble is the holder of a Life Per Capita Membership and is exempt from paying Per Capita Tax. (name of temple through which Shriners PC was purchased).

(date PC was purchased).

Date Remarks: _ ______________________________________

Witness his and our hands and seal of the temple, this day of , 20 Attest:

(Signature) ____________________________________________ Residence _____________________________________________ Age years. Profession ___________________________

_____________________________________

Attest: ______________________________

—Potentate

—Recorder

( seal )

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