MASTER'S and RECORDER'S REPORT

To be filled out in advance and handed to
the Visiting Officer at the time of his Visit
on _______________20_______
PLEASE ANSWER EVERY QUESTION

Visit ____________________, 20______

To:_______________________Council of__________________, Massachusetts





REMARKS
Additional Remarks to be made on the back of this report.

__________________________________
Illustrious Master

___________________________________
Recorder