Our Lady of Charity3620 S. 57th Ct. • Cicero, IL. 60804

P. (708) 863-1207 • F. (708) 863-1209office@olc-church.org

REQUEST FOR SACRAMENTAL CERTIFICATEIn accordance with the sacramental records policy of the Archdiocese of Chicago, sacramental certificates for persons 18 years of age and older may only be requested by the recipient of the sacrament . (Parents of a minor child may request certificates on their child’s behalf.) Identification in the form of a photo ID must accompany any request for a sacramental certificate. The completed form, along with a copy of the photo ID, may be mailed, emailed or faxed to Our Lady of Charity at the address/fax number above. Please allow 5-7 days for processing and mailing.

Sacrament: Baptism Communion Confirmation *Marriage*For a marriage certificate please indicate the full name of your spouse

Requested by:      

Address:      

City, state, Zip:      

Daytime telephone:       Date of request:     

Name at time of sacrament:      

Approximate date of sacrament:       Date of birth:      

Maiden name of mother:      

Name of father:      

Please indicate whether you prefer to pick up your certificate or have the certificate mailed to you. Hold my certificate for pick-up.

Mail my certificate to the address below. If you select this option you have to mail us a copy of your photo ID and payment.

Mail to:      

Address:      

City:       State:      Zip:     

Attention:      

Signature:       Signature of named recipient of sacrament or parent /guardian

The non-refundable fee of $10.00 per certificate and a copy of photo identification must accompany this form. Cash, cashier's checks, or money orders are acceptable forms of payment. No personal checks will be accepted. Make cashier's checks or money orders payable to Our Lady of Charity.

Office use onlyID type: __________________ Completed by: ________________ Date: _________________

Fee Paid: CA PCK CCK MO