Beloved in the Lord Jesus Christ:
As you know, we have in the past announced to you the great sin committed and grievous offence given by our fellow-member, N________, so that, by your Christian admonitions and prayers, he/she might turn to God and recover himself/herself out of the snare of the devil, who has taken him/her captive to his will. But to our great sorrow we must tell you that no one has yet appeared before us who has given us any evidence that, by the frequent admonitions given him/her (as well in private as before witnesses and in the presence of many), he/she has come to any sorrow for his/her sin or has shown the least token of true repentance. By his/her stubbornness he/she daily aggravates his/her transgression, which in itself is not small. We told you last time that if he/she did not repent, after such patience shown him/her by the church, we would, with great grief, have to come to the extreme remedy. We are therefore now compelled to proceed to his/her excommunication according to the command and charge given us in God's holy Word; to the end that, if possible, he/she may hereby be made ashamed of his/her sins; and likewise, that by this corrupt and as yet incurable member we may not put the whole body of the church in danger; and that God's name may not be blasphemed.
Therefore, we elders of the church of God at this place, being assembled in the name and the authority of our Lord Jesus Christ, declare before you all that for the previously mentioned reasons we have excommunicated and hereby do excommunicate N________ from the church of the Lord. We further declare that, so long as he/she persists obstinately and impenitently in his/her sins, he/she is excluded from the fellowship of Christ, of the holy sacraments, and of all the spiritual blessings and benefits which God promises to and bestows upon his church. Therefore he/she is to be accounted by you as a Gentile and a publican, according to the command of Christ, who says that whatever his ministers shall bind on earth shall be bound in heaven.
Further we exhort you, beloved Christians, to keep no company with him/her, so that he/she may be ashamed; yet count him/her not as an enemy, but at times admonish him/her as you would a brother/sister.
In the meantime let every one take warning by this and similar examples to fear the Lord and diligently take heed of himself, if he thinks he stands, lest he fall; but having true fellowship with the Father and his Son Christ, together with all believing Christians, remain steadfast therein to the end, and so obtain eternal salvation. You have seen, dear brothers and sisters, in what manner this our excommunicated brother/sister began to fall and gradually has come to ruin. Learn, then, from him/her how subtle Satan is in bringing us to destruction and drawing us away from all salutary means of salvation. Guard yourselves, then, against the least beginnings of evil, and according to the admonition of the apostle, Let us throw off everything that hinders and the sin that so easily entangles, and let us run with perseverance the race marked out for us. Let us fix our eyes on Jesus, the Author and Perfector of our faith (Hebrews 12:1-2). Watch and pray so that you will not fall into temptation (Matt 26:41). Today, if you hear his voice, do not harden your hearts (Heb 3:15), but continue to work out your salvation with fear and trembling (Phil 2:12). Let us all repent of our sin, lest our God humble us again and we have cause to mourn for one of you; but may you, living in godliness together, be our crown and joy in the Lord.
But since it is God who works in us both to will and to work, for his good pleasure, let us call upon his holy name and confess our sins:
O righteous God, merciful Father, before your high majesty we blame ourselves for our sins and acknowledge that we have justly deserved the sorrow and pain caused us by the excommunication of this our late fellow-member; indeed, if you would enter into judgment with us, we all deserve to be excluded and banished from your presence on account of our great transgression. But, O Lord, be gracious to us for Christ's sake. Forgive us our trespasses, for we heartily repent of them; and work in our hearts an ever increasing measure of sorrow for them, that we may fear your judgments which you bring upon the stiff-necked and may endeavour to please you. Grant that we may avoid all pollution of the world and of those who are excluded from the communion of the church, in order that we may not take part in their sins, and that he/she who is excommunicated may become ashamed of his/her sins. And since you do not desire the death of the sinner, but that he/she may repent and live, and since your church is always open for those who return, kindle, therefore, in our hearts a godly zeal, that we, with good Christian admonitions and example, may seek to bring back this excommunicated person, together with all those who through unbelief and recklessness of life go astray. Add your blessing to our admonitions, that we may have reason to rejoice again in them for whom we must now mourn, so that your holy name may be praised, through our Lord Jesus Christ, who has taught us to pray: