FORM OF LETTER OF DISMISSION

The _____ __ _______________ church of _____ ______ _______

To the ____ ___ ______________church __ _______ __________________

Dear Brothern:

This is to certify that ___________________ is a member of the church of God and regular standing. And is at own request here-by dismissed from us to unite with you.

When we receive notice from you that __________ _____________ has united with you church. Connection with us shall cease.

May the blessing of God rest on _______ ___________ and you.

Given by order, and in behalf of the ___________ ___________church

________________________Church Clerk

Date __________________