Local Church Clerk Certification Form No.

North – Central Mindanao Conference

OFFICE OF THE LOCAL CHURCH CLERK
________________________ SDA Church
______________________________________
(Complete Address)

________________________________
Date

To Whom it May Concern:

We certify that, among others, the following facts of baptism appear in our Church Clerk
Book ___________________ SDA Church, on page _______, of book number ________, to wit:

Name:

Sex: ( ) Male ( ) Female

Date & Place of Birth:

Date & Place of Baptism:

Minister Who Baptized:

Name of Father:

Name of Mother (Maiden Name)

This certification is issued to _______________________________________________
to support his/her request for issuance of baptismal certificate to North – Central Mindanao
Conference Secretariat Department, Cagayan de Oro City.

Certified True and Correct:

Verified by:

__________________________, Church Elder ___________________________, Church Clerk

(Signature Over Printed Name) (Signature Over Printed Name)

Note: Any mark, erasure or alteration of the entries invalidates this certification.