Forms/Certificates

Certificate of Dismissal L.S.

This is to certify that ________________________ and _________________________________ has (have) been (a) member(s) of the _________________ Protestant Reformed Church ____________________________ until the date specified below.

Upon ______________ request this certificate was given him (them).

Done in consistory __________________________

___________________, President

_______________________, Clerk

(Cf. Acts of Synod, 1945, Arts. 40, 51; Acts of Synod, 1946, Arts. 17, 19.)

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