This certifies that ____________ has been up to this date a(n) _______________* in good standing in the ______________ District of The Wesleyan Church, and being desirous of removing from The Wesleyan Church, is hereby released and cordially recommended to the Christian confidence of those to whom this letter may be presented.
By the authority and on behalf of the _________________ District of The Wesleyan Church, this ______ day of __________, AD ________.
________________________ District Superintendent
It is understood that this letter terminates immediately any relationship the bearer may have had to The Wesleyan Church as a minister or special worker.
(*Insert the proper term, namely ordained minister, commissioned minister, licensed minister, ministerial student, commissioned special worker or licensed special worker. If licensed special worker, add the particular type of service, such as licensed special worker—director of music, director of spiritual formation, youth director, song evangelist, children’s worker, spouse in ministry, lay evangelist or social worker.)