Presbytery Remittance Form

Date:
MM slash DD slash YYYY
Sent by (name):
First Last
Church Name:
City
City
Please make sure all info is filled out completely and accurately.
Enclosed is a check in the total amount of:
$
Check #
$
Check #
Per Capita $
Payment on Presbytery invoice $
Presbytery Giving
Harvest Offering $
$
Cents-Ability/GA Portion
$
Other (Please specify):
Please choose from one of the following options: Shared General Mission Support
1.
$
As recommended to the Session by our Presbytery, Synod and General Assembly as outlined below:
40% for General Assembly Mission $
19% for Synod Mission $
41% for Presbytery Mission $
100%
OR
2.
$
As recommended by our Session as outlined below:
% for General Assembly Mission
$
% for Synod Mission
$
% for Presbytery Mission
$
100%
Synod Special Offerings $
(Please specify)
General Assembly Special Offerings
One Great Hour of Sharing $
Peace & Global Witness (please fill out info) $
Pentecost $
Christmas Joy $
Theological Fund $
Presbyterian Disaster Assistance (must have number if not just PDA) $
Designation#:
Other $
Other (Must have Designation#):
Peace & Global Witness
GA - 50% of total collected $
Presbytery - 25% of total collected $
Your church keeps 25% of total collected to be kept for local entity.
Please make sure that you have written all of the amounts on the correct lines. Please make sure that you make copies of this form for your records. If you need to send more than one check at one time, you may use this form, as long as you note the check amounts and check numbers. Thanks for your help with this auditor-required form that needs to accompany every check that is sent to the Presbytery.

Presbytery Remittance Form

Presbytery of Des Moines

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