Letter of Transfer

This is to Certify that the person(s) whose name(s) appear(s) below is (are) registered or enrolled in:

Church _______________________________________________________

Street ________________________________________________________

City _____________________ State ______________ Zip _____________

In the Diocese of _______________________________________________

Name(s) and Confirmation dates of members being transferred:

Name ________________________________________________________

Date of Birth _______________ Date of Baptism _______________

Communicant (Yes/No) ________ In Good Standing (Yes/No)_________

Confirmation Date _______________

Name ________________________________________________________

Date of Birth _______________ Date of Baptism _______________

Communicant (Yes/No) ________ In Good Standing (Yes/No)_________

Confirmation Date _______________

Name ________________________________________________________

Date of Birth _______________ Date of Baptism _______________

Communicant (Yes/No) ________ In Good Standing (Yes/No)_________

Confirmation Date _______________

Name ________________________________________________________

Date of Birth _______________ Date of Baptism _______________

Communicant (Yes/No) ________ In Good Standing (Yes/No)_________

Confirmation Date _______________

I, the undersigned, do hereby transfer the above-named Member(s) to the spiritual charge of the Rector/Vicar/Minister of the Parish or Congregation of:

Church _______________________________________________________

Street ________________________________________________________

City _____________________ State ______________ Zip _____________

In the Diocese of ______________________________________________,

pursuant to the provisions of the Canons.

Please acknowledge the acceptance of this Letter of Transfer as soon as possible. Upon receipt of acknowledgment, the name(s) of the Member(s) will be removed from the register of the Parish.

Given under my hand (and seal), this ________________________ day of

__________________________________________, A.D., ______________.

Signed (Rector/Vicar/Warden) ___________________________________

DEUS-FM005