Decline Compensation Form

Decline Compensation Form
Date*

MonthDayYear
Date
Name of Local Church*
Pastor's Name*

First NameLast Name
Treasurer's Name*

First NameLast Name
Pastor's Email*
example@example.com
Treasurer's Email*
example@example.com
Address of Local Church*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pastor blanks* has agreed to not receive the following in salary for serving as pastor of the local church at {nameOf}.
TO NOT RECEIVE:*

100% of Tithes___________ % of Tithes$__________ per Month in Tithes
% of Tithes
$ per Month in Tithes
Date Recorded and Submitted to Local Church*

MonthDayYear
Date
The local church treasurer is to forward ten percent of tithes to the International Offices, and the designated amount required by the state/regional/national office. Also, since the pastor is not receiving the tithe, ten percent of what the pastor would typically receive should be forwarded to the state/regional/national office.
Note: A signed copy of this document should be provided to the pastor and the original kept in the church files. Once this document is recorded in proper business conference, the tithes received will be used at the discretion of the local church, finance committee, or board of directors.

Note: A signed copy of this document should be provided to the state/regional/national bishop, pastor, and the original should be kept in the church files.
Pastor's Signature*
Treasurer's Signature
Should be Empty: