Baptismal Certificate Request

Baptismal Certificate Request
Full Name at the time of Baptism*
(Rec'd _________ Mailed ___________)
Date of Birth*

MonthDayYear
Date
City / State of Birth*
Father's Full Name*
Mother's Full Name with Maiden Name*
Approximate Date of Baptism
Name of person requesting certificate*
Must be parent or guardian of minor - or your own name if 18+
Street Address*
City, State AND Zip Code*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
In order to protect the privacy of the individuals involved, certificates are only issued to the parent of a minor child, or the person to whom the certificate is referring. NO certificates are issued for genealogical purposes (or after death).

I have read the above information, and certify that this is my own or my minor child's certificate that I am requesting.
Your Signature*

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Would you like a copy submitted to St. Anastasia's Religious Education Office?

YesNo
If requesting to be sent to another Parish, type in the name of the Parish:
To the attention of:
Address of Parish where you would like this certificate mailed:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty: