Personal Information

Age: (    67     ), Marriage Status: Married(   x  ) Single(      ),

Gender: Male (        ) Female(    x     )

Position in the Church

Atheist (         ), Church Member(  x        ), Deacon(           ), Elder(           ),

 Catechist(         ), Pastor’s wife(         ), Pastor(           )

Belief History

None(            ), Born as Christian(     3     generation), First Generation (         years)

Attending Church

(         Calvary Chapel Old Bridge                     ) Church

Reason for requesting deliverance;

Sickness (Physical)

 High blood pressure.

 MDS

 Kidney Syst

 Joint Pain

 Lower Back Pain

Spritual Difficulties : 

 Sometimes Sadness prevents from praying.

 Free from guilt, shame, anger, … etc.

 Break from the generational spirit

 Be close to Jesus (as friends)

 break from inner vows

 break away from the occult spirit (used practice New Age)

Any other reason : 

 Be love husband more.

Requesting Date and Day

 Requesting date :  8/31/2012

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please check your deliverance date.