SACRAMENTAL RECORDS REQUESTS

SACRAMENTAL RECORDS RELEASE REQUEST

Request Date:

NAME OF PARISH IN WHICH SACRAMENT WAS PERFORMED:
NAME OF SACRAMENT: BAPTISM MARRIAGE COMMUNION CONFIRMATION OTHER
NAME AT TIME OF SACRAMENT:
APPROXIMATE DATE OF SACRAMENT:	DATE OF BIRTH:
NAME OF FATHER:
MAIDEN NAME OF MOTHER:

REQUESTOR:

ADDRESS:

CITY, STATE, ZIP:

DAYTIME TELEPHONE NUMBER:

SEND TO:

ADDRESS:

CITY, STATE, ZIP:

ATTENTION:

SIGNATURE: ____________________________________________________________________________________

(SIGNATURE OF NAMED RECIPIENT OF SACRAMENT OF AUTHORIZED RECIPIENT OF DOCUMENT)

For Office Use Only

ID Type:	Fee Paid: CA CK MO
Researcher:	Date Mailed:

THE NON-REFUNDABLE FEE OF $10.00 PER CERTIFICATE AND A COPY OF A PHOTO IDENTIFICATION MUST ACCOMPANY THIS FORM. CERTIFICATE REQUESTS MADE FOR GENEALOGICAL PURPOSES ARE $20.00. CASH, CASHIER'S CHECKS, OR MONEY ORDERS ARE ACCEPTABLE FORMS OF PAYMENT. UNFORTUNATELY, NO PERSONAL CHECKS WILL BE ACCEPTED. MAKE CASHIER'S CHECKS OR MONEY ORDERS PAYABLE TO THE ARCHDIOCESE OF CHICAGO.

GENERAL INQUIRIES: info@archchicago.org

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Archdiocese of Chicago's Joseph Cardinal Bernardin Archives & Records Center
711 West Monroe
Chicago, Illinois 60661
Tel. (312) 831- 0711
Fax: (312) 831- 0610
Vice Chancellor: jtreanor@archchicago.org

Webmaster: motoole@archchicago.org

06/20/07