
To the Rector or Vicar of:
Church_______________________________________________________
Street________________________________________________________
City_____________________ State_______________ Zip______________
Please Send an official Letter of Transfer for me / us to:
Church_______________________________________________________
Street________________________________________________________
City_____________________ State_______________ Zip______________
Signed _______________________________________________________
Print Name____________________________________________________
Effective date of transfer from church now leaving___________________
Name and Confirmation dates of members being transferred:
Name________________________________________________________
Confirmation Date______________________________________________
Name________________________________________________________
Confirmation Date______________________________________________
Name________________________________________________________
Confirmation Date______________________________________________
Name________________________________________________________
Confirmation Date______________________________________________
Name________________________________________________________
Confirmation Date______________________________________________
DEUS-FM004