Masonic Temple / Blue Lodge / Grand Lodge of Pennsylvania Masonic Temple One North Broad St. Philadelphia / Grand Lodge of Pennsylvania / /
Holiday
Commonwealth Day / /
Organization
TO BE COMPLETED BY ORGANIZATION / Bureau of Motor Vehicles in Harrisburg / Your Masonic Fraternity / Pennsylvania Department of Transportation Bureau of Motor Vehicles / CITY STATE ZIP CODE TO BE COMPLETED BY ORGANIZATION NAME OF ORGANIZATION / Masonic Fraternity / DEPARTMENT OF TRANSPORTATION / Section B. NAME OF ORGANIZATION / Freemasonry / ABOVE NAMED ORGANIZATION / Return Tag Unit / /
Person
I CERTIFY / I CERTIFY THAT / / /
Position
OFFICIAL / Grand Secretary / GENERAL INFORMATION REGARDING / TITLE SIGNATURE GRAND SECRETARY / /