Sacramental Record Request

Requestor's Full Legal Name*

Relationship to person needing certificate*
SelfMotherFatherLegal GuardianOther

Current Address*

City*

State*
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Zip*

Phone Number*

Email Address*

I certify that I am requesting a Baptismal Certificate for myself or my minor child. I understand that this online request will allow St. Timothy Catholic Church to send this record to the church I indicate.

Full Legal Name of Child/Adult of record*

Date of Baptism or Sacrament requested*

Date of Birth*

Place of Birth*

Father's Full Legal Name*

Mother's Full Legal Maiden Name*

Name and Address of Destination Church*

Additional Comments