Key Statement of Issue

I, ______________________________, have been issued the following key(s) for use at NewHeart MCC/UCC.

Please circle, highlight or fill in:

Entry (Key #) __________ Sanctuary/Sunday School (Key #) __________

Pastor’s Office Clerk/Treasurer Office Youth Pastor’s Office

Office Storage Room Sunday School Storage Back fence padlock

Lock box Lift Key

Other (specify) ___________________________________________________________

I acknowledge that by signing this document it is my responsibility to follow the following guidelines:

1. Key(s) will not be shared with, loaned or transferred to another individual on a temporary or permanent basis.
2. I will not copy or duplicate this/these key(s).
3. I will notify the Pastor and clerk if this/these key(s) is/are lost/stolen.
4. I will return this/these key(s) if I no longer needed, if damaged, or replacement(s) is/are issued, upon request. Failure to return keys will result in your being required to reimburse the church for re-keying of all applicable locks.

Issued To: ____________________________________ (Printed Name)

Signature: ____________________________________

Church Staff member: __________________________ (Printed Name)

Signature: ____________________________________

Title: ________________________________________

Date Issued: __________________________________

Returned To: __________________________________ (Printed Name)

Signature: ____________________________________

Date Returned: ________________________________

This document to be retained as a permanent record for a period of five (5) years after key(s) is/are returned.

Approved: April 6, 2008