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. MAIL TO 711 W. MONROE ST., CHICAGO IL 60661.

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) 534-4400
Fax: (312) 831- 0610
Vice Chancellor: jtreanor@archchicago.org

Webmaster: mlavelle@archchicago.org

11/09/10