Form MEPS 445 DLD (05) Page 1 of 2 March 2005
THE UNITED CHURCH OF CANADA
Ministry and Employment Policies and Services (Pastoral Relations)
Disciplinary Discontinued Service for
Order of Ministry (MEPS 445 DLD)
This form must be used by a presbytery/district requesting that a minister’s name be added to the Discontinued
Service List (DSL). Please see The Manual, sections 33a, 75k (v), 314d (i), and 427.2.
Routing:
• Presbytery/district completes Parts A and B.
• Form is forwarded to Conference Executive Secretary.
• Conference Executive Secretary completes Part C and forwards to Ministry and Employment Policies and
Services (Pastoral Relations).
• Every person who signs this form must keep a copy for his/her own records.
Part A: Identification of Minister
Minister’s name:
Category of ministry: Ordained Minister Diaconal Minister
Postal address:
Post office box/street address City Province Postal code
Telephone:
Home Office
Fax E-mail
Current presbytery/district:
Part B: Presbytery/District Recommendation
Presbytery/District recommends that
be placed on the Discontinued
Name of minister
Service List and documentation of the relevant discipline or oversight action is as follows:
Month/Day/Year Signature: Authorized presbytery/district officer Printed name: Authorized presbytery/district officer
The use, retention, and disclosure of personal information collected from this form is done in compliance with privacy legislation including, but
not limited to, the Personal Information Protection and Electronic Documents Act (2000, c.5). ** THIS FORM IS NOT VALID IF ALTERED **
Form MEPS 445 DLD (05) Page 2 of 2 March 2005
Disciplinary Discontinued Service for
Order of Ministry (MEPS 445 DLD) cont.
Part C: Conference Action
Conference has made a decision to list
Name of Conference
on the Discontinued Service List. Attached
Name of minister
is the following documentation on the formal process upon which this action was based:
Copies of this record have been circulated to Ministry and Employment Policies and Services (Pastoral Relations),
presbytery/district, and the person in accordance with the policies and practices of The United Church of Canada.
Month/Day/Year Signature: Conference Executive Secretary Printed name: Conference Executive Secretary
The use, retention, and disclosure of personal information collected from this form is done in compliance with privacy legislation including, but
not limited to, the Personal Information Protection and Electronic Documents Act (2000, c.5). ** THIS FORM IS NOT VALID IF ALTERED **