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6040. Letter Given to Person Desiring to Withdraw from the Church (592; Gen. Bd. Policy on Ch. Disc. 5048).

This certifies that ____________, the bearer, has been up to this date a member of the ______________ Wesleyan Church, and being desirous of withdrawing from said Church, is hereby declared to be withdrawn.

By authority and in behalf of the ______________ Wesleyan Church, this ______ day of __________, AD ________.

________________________ Pastor ________________________ Local Church Secretary

(It is understood that this letter of withdrawal terminates the bearer’s membership in The Wesleyan Church immediately.)