§ Form of the Certificate of Appointment or Admission of a Probationer.
§ To the justices of the peace at the general session of the peace to be holden for the county of We, whose names are hereunto subscribed, being respectively dissenting ministers, duly qualified according to law, in the sect or persuasion denominated [here describe the sect], do certify that A. B. of is a person of sober life and conversation, and has been known to us for the space of before the date of this our certificate, and hath been appointed or admitted by us as a probationer for the exercise of the functions of a Protestant Dissenting minister for the term of, after qualifying himself as required by law. Given under our hands this day of in the year of our Lord
| Signed and subscribed by the above-named C. D. E. F., G. H., I. K., L. M., and N. O., in the presence of P. 2., of the day above-written. | (Signed.) |
| C. D. | I. K. |
| E. F. | L. M. |
| G. H | N. O. |