Form 5

To the ___________________ [name of the presbytery] _____________________ meeting on the _______________________ day of ____________________ in the year _____________, at __________[location of the meeting]______________.

The ________ [name and location of the congregation] ___________________, being without a teaching elder serving as its pastor, the Session hereby petitions its presbytery to grant them the moderation of a Call, and to appoint an elder to moderate in the election.

Given this ______________________ day of ______________________ in the year _________________, by order of the Session.

_____________________________ ______________________________ Clerk of the Session Moderator of the Session