Annunciation Sacramental Certificate Request Form

Annunciation Sacramental Certificate Request Form
Church of the Annunciation
509 W. 54th St.
Minneapolis, MN 55419-1818
www.annunciationmsp.org

Contact: Helen Corkran
Email: sacramentrequest@annunciationmsp.org

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 requesting parish or diocese.

No certificates are issued for genealogical purposes.
Name of individual at time of sacrament*

First NameLast Name
Birthdate*

MonthDayYear
Date
Which documents are you requesting?*
Place of Birth - City, State

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Name*

First NameMiddle NameLast Name
Mother's Maiden Name*
Father's Name*

First NameMiddle NameLast Name
Relationship to individual whose certificate is being requested*
Date of Sacrament Conferred*

MonthDayYear
Date
Was the Sacrament conferred at The Church of the Visitation? (Merged with The Church of Annunciation on July 1st, 2012)*

YesNo
Requester's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Requester's Email*
example@example.com
Requester's Phone Number*
Please enter a valid phone number.
Name of Church to mail certificate to
Attention
Church Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By Signing below, you agree that:
- I certify that I have read the above information and that I am requesting my own certificate or that of my minor child.
Signature*

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Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
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