To the ________________________ Monthly Meeting,

Address ________________________ Postal Code ________

Dear Friends,

This CERTIFICATE OF TRANSFER has been requested by a member of this monthly meeting who now resides in your area. We have given consideration to this request, and, no obstruction appearing, we recommend ________________________ to your Christian care and remain with love your friends.

Removal minutes (date) ________ by the ________________________
                                                               Monthly Meeting,

Address ________________________


(Signature of monthly meeting clerk or of a membership records clerk)

enclosure: ACCEPTANCE OF TRANSFER form, PARTIALLY filled in by us. Only when you complete the form and return it to us will the transfer be concluded.