Application for Diocesan Loan Relief

The Episcopal Diocese of Massachusetts

Diocesan Loan Committee	Phone: 617-482-4826 ext. 413
c/o Treasurer's Office	email: nfasman@diomass.org
138 Tremont Street
Boston, MA 02111

Application Date*

Church ID

Church Name*

Church Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Church Phone*

Church Email*

Type of Loan*

Stokes Loan Green Loan

Please indicate the type of loan for which you seek relief.

Loan Number

Please provide the originating loan's tracking number assigned by the Treasurer's Office.

Relief Purpose*

Senior Warden's Name*

Prefix (optional)

First Name

Initial (optional)

Last Name

Suffix (optional)

Senior Warden's Email Address*

Confirm Senior Warden's Email Address *

Senior Warden's Signature*

[clear]

Signature of authorized representative of the above named church, mission, or congregation with approval by either the Rector or Priest-in-Charge. Use your mouse or finger to draw your signature above.

Treasurer's Name*

Prefix (optional)

First Name

Initial (optional)

Last Name

Suffix (optional)

Treasurer's Signature

[clear]

Use your mouse or finger to draw your signature above

Rector/PIC's Name*

Prefix (optional)

First Name

Initial (optional)

Last Name

Suffix (optional)

Rector/PIC's Signature

[clear]

Use your mouse or finger to draw your signature above

DLC Approval Date

DLC Notes