Sacrament Certificate Request Form

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- Please complete this form to the fullest extent possible. In order to protect the confidentiality of these records certificates will 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 the person whose certificate is being requested REQUIRED Please fill out this field. Please enter valid data.
- Other names by whom this person has been known (maiden name, etc.) Please enter valid data.
- Name of the person requesting certificate REQUIRED Please fill out this field. Please enter valid data.
- Relationship to person whose certificate is being requested REQUIRED Self Parent of minor child Please fill out this field.
- Certificate requesting Baptismal certificate First Communion certificate Confirmation certificate Marriage certificate
- Date Sacrament conferred (or birth date for Baptismal Certificate) Please enter valid data.
- Date of Birth (if date of sacrament is unknown) Please enter valid data.
- Requestor's contact information:
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City, state and zip code REQUIRED Please fill out this field. Please enter valid data.
- Daytime phone number REQUIRED Please fill out this field. Please enter valid data.
- Email address Please enter valid data.
- I certify that I have read the above information and that I am requesting my own certificate or that of my minor child.
- Comments or instructions Please enter valid data.
- Electronic signature (Please type your first and last name) REQUIRED Please fill out this field. Please enter valid data.
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St. Mary of the Lake

Catholic Church - Plymouth, MN

Sacrament Certificate Request Form