Form 12

This is to certify __________ [name of the one to be certified] _________ has been examined and approved by the __________ [presbytery] ___________ of the Reformed Presbyterian Church of North America to be a candidate eligible for a call as a pastor in the church.

This licensure is for a term of five (5) years. He may not administer the sacraments, perform marriages, nor pronounce the benediction.

Given this _____________ day of _______________ in the year ________, by order of the Presbytery.

____________________________ ______________________________ Clerk of the Presbytery Moderator of the Presbytery