Group Exemption Request Group Exemption Request Date* MM slash DD slash YYYY Organization* Jurisdiction*AlabamaArgentinaArizonaArkansasArubaBoliviaColoradoConnecticutDelawareFloridaFranceGeorgiaGermanyIdahoIllinoisIndianaIowaItalyJapanKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern California & HawaiiOhioOklahomaOregonParaguayPennsylvaniaPeruRhode IslandRomaniaSouth CarolinaSouth DakotaSouthern CaliforniaNevadaTennesseeTexasUruguayUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCity & State* Federal ID#* Chapter ID#* DeMolay International, Federal ID# 43-1722585, is hereby authorized and requested to add the name of our subsidiary organization to the Group Exemption Roster of DeMolay International. We recognize that we are a subsidiary organization of DeMolay International and agree to abide by DeMolay International's By-laws and Rules & Regulations. This authorization will remain in effect until such time as the organization is officially forfeited or a written request to the contrary is filed with DeMolay International by the presiding officer of the organization. Presiding Officer Signature* Presiding Officer Title* Δ
