MONTH month January February March April May June July August September October November December YEAR year 2012 2013 2014
I confirm that no Parochial Fees were received or due to be received for the above Parish for the month and year shown
Form completed by: Incumbent Priest in Charge Treasurer Other authorised
Please note that this form MUST only be submitted by an authorised person normally the Parish Treasurer or the incumbent
Please or the form