Sacramental Certificate Request

Sacramental Certificate Request

Please complete this form to request a copy of a certificate from a sacrament you received.
Name on certificate:*

First NameLast Name
Name of person requesting certificate:*

First NameLast Name
Email of person requesting certificate:*
example@example.com
Phone Number of person requesting certificate:*
Please enter a valid phone number.
Where was the sacrament performed?*

Holy CrossSt. Mary, Star of the SeaOur Lady of Good CounselSt. Joseph on Lee St.
Type of sacrament you are requesting a certificate for:*

BaptismFirst EucharistConfirmationMarriageFuneral
Date of sacrament performed (or approximate)*

MonthDayYear
Date
Date of birth of person named on certificate:*

MonthDayYear
Date
Purpose for request:*
Where we will send the certificate:

We will mail the certificate within 2 weeks of receipt of this form, often much sooner. Please provide info below, in case we have questions and need to contact the church/tribunal directly. Thank you!
Name of church or tribunal to whom we are sending the certificate:*
Name of contact person at church/tribunal (if known):
Email of contact person at church or tribunal:
example@example.com
Phone of contact person at church or tribunal:*
Please enter a valid phone number.
Address of church or tribunal:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If you have a particular form that needs to be signed, please either:
- email it to deb.airey@archbalt.org or
- mail/drop it off to: Deb Airey, c/o CCSB, 110 E West St, Baltimore MD 21230
Our team will ensure it is signed, stamped, and/or returned accordingly.
Anything else to add?
Should be Empty:

Sacramental Certificate Request

Where we will send the certificate: