Fill and Sign the Affidavitfor Exemption by Religious Leadergeneral Form

General Form of Affidavit for Exemption from the Draft by a Minister or Similar Religious Leader STATE OF ____________________ COUNTY OF _______________________ PERSONALLY appeared before me, the undersigned authority in and for said county _____________________ (Names of Affiant) , who, having been being first duty sworn by the undersigned Notary Public, deposes and says: 1. I reside at ______________________________________________________________ _______________ (street address, city, state, zip code) , and I am _____ (number) years of age, having been born on ______________ (date) . 2 I registered with the Selective Service System, Local Board No. _______, _______ ____________________________________________________________________________ (street address, city, state, zip code) , on _______________ (date) , and filed a questionnaire on that date for exemption from military service as a (e.g., minister) __________________ . 3. I am now, and have been, a fully qualified and ordained (e.g., minister) _____________ in the (e.g. Southern Baptist Denomination) _______________________________ , since _________________ (date) , and have been actively engaged in the full-time practice of that profession since that date. I am not employed in any other capacity, and I receive no income except that received as a minister. 4. I am currently assigned to and employed by (e.g., name of church) ________________ ____________________ at ______________________________________________________ ______________________ (street address, city, state, zip code) . The name of the governing body of said Church is a Board of Deacons and the name and address of each is as follows: A.____________________ (Name of Deacon) who resides at ________________ ______________________________________________________________ (street address, city, state, zip code) ; B. __________________ (Name of Deacon) who resides at __________________ ___________________________________________________________ (street address, city, state, zip code) ; C. __________________ (Name of Deacon) who resides at __________________ ____________________________________________________________ (street address, city, state, zip code) ; 5. ______________________ (Name of Deacon) who resides at ____________________ __________________________________________________________ (street address, city, state, zip code) , is the Chairman of said Board. 6. Attached to this Affidavit is a certified copy of my (e.g., certificated of ordination) ______________________________ as a minister in the (e.g. Southern Baptist Denomination) ____________________________________ . ___________________________________ (Printed Name of Affiant) ___________________________________ (Signature of Affiant) SWORN to and subscribed before me, this the _____ day of _____________, 20____._____________________________ NOTARY PUBLIC My Commission Expires: ___________________