Sep232014
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Dissolution of Holy Union

Dissolution of Holy Union

The persons listed have a Holy Union registered with DignityUSA National Registry. The persons hereby agree that the Holy Union is dissolved and wish to have their Union removed from the Registry of DignityUSA immediately.

 

 

 Please Print

First Person

Second Person

Full Name:

 

 

Address:

 

 

City:

 

 

State & Zip:

 

 

Signature(s):

 

 

Date of Holy Union:

Chapter:

 

 

Chapter President/Representative:

________________________________________________

The individuals listed above were united in Holy Union Service.

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