The Reformed Catholic Church

 Statement of  No Record of Sex Crime Felony Charges or Convictions

Name: SSN:

                (Full Legal Name)

Alias/Religious Name:

Address:

CityStateZipCountry  

 I, an applicant to the ministry of The Reformed Catholic Church do: 

Submit this notarized statement that I have not been convicted of, nor currently  have charges pending, related to Felony Sex Crimes. 

I understand that if the information I have provided is determined by the Formation Committee to be in error or false, my application will be declined.  I further understand that if my application is declined due to the discovery of false information, the Formation Committee will have the right to permanently refuse any future application that I may submit to the Reformed Catholic Church.

By my signature below, I submit this document to the Formation Committee of the Reformed Catholic Church.

 Signature    Date

______________________________________________________________________________

Signature                                                                                  Date_____________________

NOTARY SEAL

____________________________________________ Date_____________________

I understand that I will be required to print this Statement of  No Record of Sex Crime Felony Charges or Convictions form and have it notary sealed.  The Notarized Seal form is to be mailed to: