We , the undersigned, hereby certify that we are eligible for membership in the American
Legion as provided in section 1, Article IV, of the National Constitution as above quoted, including
the Explanatory Note.
We hereby request the issuance of a temporary charter for the formation of a Post at
_______________WITHAMSVILL-MT . CARMEL OHIO (CLERMONT COUNTY)_________
to be known as __WITHAMSVILLE-MT . CARMEL________________________________Post.

No. ____72_____, Department of ____Ohio ____________________________________________

On issuance of a charter we hereby agree to organize and maintain a Post under the above name with the minimum membership designated by Department Executive Committee. We hereby further agree to uphold the principles of THE AMERICAN LEGION and to comply with all rules and regulations prescribed by the department and National Organization of the Legion

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