Sacramental Certificate Request Form

REQUESTOR'S INFORMATION

In order to protect record confidentiality, a certificate will only be issued to:

1. The individual named on the certificate
2. The parent or guardian of a minor child
3. A requesting parish or diocese
Type of certificate copy being requested*

BaptismFirst CommunionConfirmationMarriage
Name*

First NameLast Name
Relationship to the baptized person*

SelfParent/GuardianParish/Archdiocese
Parish at which the certificate was received

Our Lady of GraceMost Holy Trinity
NOTE: In order to release a certificate to a parent or guardian, the baptized person must be a minor child (under 18 years of age). If the baptized person is over 18 years of age, they will need to complete this form on his/her own behalf.
Requestor's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*

Area CodePhone Number
Email*
example@example.com

BAPTIZED PERSON'S INFORMATION
Name of the person whose certificate is being requested*

First NameLast Name
Other names by whom this person has been known (maiden name, etc.)

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Reason for certificate copy request*

First Reconciliation/CommunionConfirmationMarriageAnnulment
NOTE: No certificate copies are issued for genealogical purposes.
Approximate year that the sacrament was conferred*

AUTHORIZATION TO RELEASE INFORMATION
Please initial here to authorize Our Lady of Grace to release a sacramental certificate copy to the below listed institution.*
Name of Institution*
ATTN: *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional information:
Enter the message as it's shown*
Should be Empty: