Request for Withdrawal of Church Membership

TO: THE FIRST PRESIDENCY I desire to withdraw from membership in the Community of Christ. The reason for my request is:

______Please remove my name from church records: Signature:

Print/Type Full Name:

(Maiden Name):

Register #:

Address:

*** TO BE FILLED IN BY THE ADMINISTRATIVE OFFICER*** Ministerial contact was made on ______, and I/we have determined that he/she does in fact desire to withdraw. We therefore recommend that the withdrawal be granted.

Signed: ______(Visiting Priesthood)

______(Visiting Priesthood)

Approval: ______(Pastor)

______(Mission Center President)

COMMENTS:______NOTE TO MEMBER: The church requires a signed request from each person requesting withdrawal. This form should be given to your pastor for processing. Questions may be addressed to the World Church Secretary, Community of Christ, 1001 W. Walnut, Independence, MO 64050. NOTE TO ADMINISTRATIVE OFFICERS: Withdrawals should be approved by both the pastor and the stake or district president. Please secure both signatures before forwarding this form to the World Church Secretary.