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APPENDIX 2
CERTIFICATE OF RECEPTION FOR CHURCH MEMBERS
(The pastor of the receiving congregation should complete this form, detach, and mail to the
moderator or clerk of the session granting the letter.)
This certifies that ______________, a member in good standing of the _________________ congregation of the Cumberland
Presbyterian Church/Cumberland Presbyterian Church in America, upon presentation of a letter of dismission from the
above named congregation, bearing the date _______________, 20_____, was received by the
___________________congregation of the ___________________ Church on _________________, 20____.
Signed__________________________ (Pastor).
A permanent record of the dismissal should be kept by the clerk and should include the following:
Session Clerk's Record
Name of Member________________________________________
Address_______________________________________________
Dismissed to:
Name of congregation_____________________________________
Name of denomination____________________________________
Letter of Dismission sent to:
Name__________________________________________________
Address_______________________________________________
Date sent________________
Certificate of Reception returned: Date received________________
Note: If Certificate of Reception is not returned in six months, inquiry should be made.
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