Form 19
Name: ________________________________________________________________________________ Address: ______________________________________________________________________________ Phone: (____) ______-________ Email address: ______________________________________________ Recognition of Transfer of Membership To the Annual Conference (To be completed by District Superintendent)
Local Church at which this person holds membership: _______________________________________________ District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR On _________________________ (date) the above-mentioned individual received a license to preach. Having become a Local Pastor, the above-named person is now a member of the Annual Conference and their membership is transferred to the Annual Conference.
Recognition of Transfer of Membership From the Annual Conference (To be completed by District Superintendent)
On _________________________ (date) the above-mentioned individual had their license to preach revoked. Reason for revocation [__] Discontinued by DCOM [__] Lack of suitable appointment [__] Surrendered license [__] Other: ______________________________________________________________ Local Church to which this persons membership will be transferred: ____________________________________ District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR
Signature:
I hereby certify that all the information I have provided is true and accurate.
_______________________________ __________________________ __________________________ DS: Signature
Printed name
Date
Copies: [__] DCOM - Retain original in Local Pastor’s DCOM file [__] Email completed copy to ConferenceSecretary@holston.org Office Use Only: Upon receipt of this form, the Secretary of the Annual Conference shall notify the local church that [__] the person is being transferred to the Annual Conference and that the name should be removed form the roll or [__] the person desires to join via transfer. _________________________ (date) Letter was sent to the Local Church. Update: 2020-11