REQUEST A SACRAMENT CERTIFICATE
Our Lady of Mt. Carmel Church, 2700 Dover Ave., Fairfield, CA 94533 (707) 422-7767 [email protected]
Today’s Date: ______________________________
Only the person(s) named on the sacramental certificate, with a current valid photo ID, may submit a request. A parent / legal guardian can request a copy of a certificate on behalf of a minor. No certificates will be sent via email. Please allow 1-10 business days for complete on. (ONE FORM PER SACRAMENT CERTIFICATE REQUEST)
I am requesting ng a certificate copy of my:
□ Baptism □ First Communion □ Confirmation □ Marriage
· Approximate month and year the sacrament took place: ___________________________· Full name of the person for whom the sacrament was for: Last name___________________
First name _____________________________Middle _____________________________ ·
Date and place of birth of the person for whom the sacrament was for: DOB_______________________ Place of birth ________________________________.
Mother’s first and maiden name: _______________________________ Father’s full name: _________________________________________
For Marriage Certificate request please provide additional information: ·
Date of marriage: ___________________________________________ ·
Full name of the contracting parties for whom the sacrament was for: Husband__________________________ Wife _____________________________
Witnesses: 1________________________________2_________________________
YOUR INFORMATION: Your relationship to the person named on the certificate:
□ Self □ Parent □ Other (Please submit a copy of a valid photo i.d.) ·
Your FULL name: ___________________________________________________________ · Your email: ___________________________Contact number: ______________________ · Your mailing address: __________________________________________________________________
DELIVERY PREFERENCE: □ Pick UP □ Mail to given address
***Suggested donation of $10.00 per certificate. We depend on your support to maintain our ministries and church facilities. Thank you.