Request a Copy of a Baptismal Certficate
Instructions
Please use this form to request a copy of a Baptismal Certificate. Provide any information on the BAPTIZED PERSON you have to assist us in finding the requested record. (An individual must have been baptized at St. Matthew's Church for a certificate to be prepared. We cannot prepare Baptismal Certificates for other parishes. Copies of Baptismal Certificates are only provided by the Church of Baptism, even if you received other sacraments in other parishes.)
Are you making this request for yourself as the BAPTIZED PERSON or are you acting as an AGENT on behalf of the BAPTIZED PERSON?
SELF: This request is your request for your Baptismal Record.
AGENT: This request is being made by you on behalf of the BAPTIZED PERSON
F
u
l
l
N
a
m
e
o
f
B
A
P
T
I
Z
E
D
P
E
R
S
O
N
w
h
o
n
e
e
d
s
t
h
e
c
o
p
y
o
f
t
h
e
B
a
p
t
i
s
m
a
l
C
e
r
t
i
f
i
c
a
t
e
(
"
B
A
P
T
I
Z
E
D PERSON")
BAPTIZED PERSON First Name
*
BAPTIZED PERSON Middle Name
*
BAPTIZED PERSON Last Name
*
BAPTIZED PERSON's Date of Birth
*
/
Month
/
Day
Year
Date
Approximate Date of BAPTIZED PERSON'S Baptism (if known - provide month, year)
/
Month
/
Day
Year
Date
BAPTIZED PERSON'S Daytime Phone Number in case we have to make contact about this request
*
Format: (000) 000-0000.
AGENT'S Full Name:
First Name
Last Name
AGENT'S Daytime Phone Number in case we have to make contact about this request
Format: (000) 000-0000.
Email Address to send Confirmation of this request
*
example@example.com
BAPTIZED PERSON'S Mother's First and Maiden Name
BAPTIZED PERSON'S Father's Name
BAPTIZED PERSON'S Sponsor("Godparent") (Only one name is needed here)
How would the BAPTIZED PERSON like to receive the Copy of the Baptismal Certificate?
By Mail (provide the mailing address below. We will need to verify this address.)
Pick up at the Parish Center (35 North Service Road, Dix Hills, NY)
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please verify that you are human
*
Submit
Should be Empty: