Ministry Request Form
Personal Information
Age: ( 73 )
Marriage Status: Married( x ) Single(
),
Gender: Male (
) Female( x )
Position in the Church:
Atheist
( ), Church
Member( ),
Deacon( ),
Elder( ),
Catechist(
), Pastor's wife( x ),
Pastor( )
Belief History
None( ),
Born as Christian( ), First Generation ( 48 years )
Attending Church
( None ) Church
Reason for requesting
deliverance;
Sickness
(Physical):
Constipation, Chronic headache, pain
in body with unknown reason, stomach pain, and amnesia
Spritual Difficulties:
Anxiety, irritation, difficulty socializing with people, and feeling
spiritually oppressed
Date requesting: 2/2/17 Thursday