Concordia Evangelical Lutheran Church

Claim Request for Donated or Church Items

Date_________________________

Last Name: ___________________________________

First Name: ___________________________________

Address:      ___________________________________

Phone: Home ­­­­­­______________  Work ______________ Cell ______________

E-mail:  ____________________________ 

Item Requested (please note if you donated any requested items):

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Committee Use:

Date Received:______________   Date Approved: ________________    Date Responded:_______________