App 14 Application: Self-Initiated Discontinuance as a Local Pastor (FL) (PL) (Âś320.1) Name:
______________________________________________________________________
Address:
First
Middle
Last
______________________________________________________________________ Street
City
State
Zip
Best Contact # (______)________-__________ Birthdate: _________ _________ __________ [__] Cell [__] Home [__] Work Month Day Year Email: ______________________________________________________________________ Clergy Status: [__] Full-time Local Pastor (FL) [__] Part-time Local Pastor (PL) District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR Charge: ______________________________________________________________________ Having prayerfully considered my current pastoral call, I believe that I am no longer called to serve as a Local Pastor in the United Methodist Church.
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[__]
I, therefore, voluntarily initiate a discontinuance of my License to Preach. I understand that I must return my License to Preach, my Local Pastor Licensing School (LPLS) Certificate of Completion and other credentials to the District Superintendent for Deposit with the Secretary of the Annual Conference. I further designate ____________________________________ United Methodist Church in the _______________________________ District of the Holston Annual Conference as the church to which my membership shall be transferred.
__________________________ Signature
_________________________ Printed Name
___________________ Date
Please submit copies of this application to: [__] The Office of Clergy Services via ClergyServices@holstn.org [__] Current District Superintendent [__] DCOM
_____________________________________________________________________________________ District Superintendent - Office Use: [__] Pastor surrendered License to Preach: [__] Pastor surrendered LPLS Certificate: [__] Circumstances that should be noted:
Month Day Year _________ _________ __________ _________ _________ __________ ________________________________________________________________ ________________________________________________________________ DS Mailed surrendered materials to Conference Secretary: [__] License to Preach: _________ _________ __________ [__] LPLS Certificate: _________ _________ __________ BOM follow-up with Episcopal Office: _________ _________ __________ [__] Episcopal Office was informed of the Discontinuance and the reasons for discontinuance.
Updated: 2020-11