St. James Census Form printable pdf download

St. James Census Form

Last

First

Mr. Mrs. Ms. Miss

Name______________________________ Name______________________________ Dr. M/M

Spouse’s First

Name______________________________ (Maiden Name)________________________________________

Home Address___________________________ City__________________________, NY Zip___________

Phone No: Home______________________ Cell_______________________ Work___________________

Email address_____________________________________________________________________________

St. James is working on being a Green Organization. Please provide us with an email address to save on paper and postage. We promise not to

inundate your mailbox with spam or junk mail or give out your address. Thank you, we appreciate your cooperation.

Sacrificial Giving:

please check one

receive envelopes______

sign-up credit card______

Electronic Fund Transfer (EFT)______

Office Use only:

ID #__________

Neighborhood #__________

WC Mailed__________________

Input Date_____________

Card Mailed______________

St. James Census Form