Sacramental Certificate Request

Please complete this form to the fullest extent possible.

In order to protect the confidentiality of these records, certificates will only be issued to the individual named on the certificates, the parent or guardian of a minor child, or a parish or diocese.

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Requesting:
Requester's Contact Information

I certify that I have read the above information & that I am requesting my own certificate or that of my minor child.

Your Signature