Subject: Resignation of membership in LDS church
My full name is ______; my date of birth is ____________ . [I was baptized on ___(date). My membership number is ______.]
My residence address is _______ [in the ________ ward/branch].
I hereby resign my membership in the Church of Jesus Christ of Latter-day Saints, effective immediately, and request you to remove my name permanently from your membership records. I wish no further contact from representatives of your church except to confirm that my name has been removed from your records. I expect to receive that confirmation within a reasonably short time.
You don't actually need your membership number but use it if you have it.