763-497-2745

Baptismal Certificate Request Form

- Church

Baptismal certificate request form
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- St. Michael Catholic Church
  11300 Frankfort Parkway NE
  St. Michael, MN 55376
  763-497-2745
  https://www.stmcatholicchurch.org/
  Email: dlarson@stmcatholicchurch.org
- Please complete this form to the fullest extent possible. In order to protect the confidentiality of these records, certificates will only be issued to the individual named on the certificate, the parent or guardian of a minor child, or another parish.
- Today's Date REQUIRED Please fill out this field. Please enter a date.
- First, Middle & Last name of the person whose certificate is being requested Please enter valid data.
- Other names by which this person has been known (maiden name, etc) Please enter valid data.
- Date of birth of the person whose certificate is being requested REQUIRED Please fill out this field. Please enter a date.
- Date of baptism (if known) Please enter a date.
- Name of the person requesting the certificate Please enter valid data.
- Relationship to person named on the requested certificate Self Parent/guardian of a minor child
- Phone number of requestor REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Email of requestor REQUIRED Please fill out this field. Please enter an email address.
- Reason for request
- Please indicate whether: Staff should mail the requested certificate to another church Requester will be picking up the certificate at the parish office
- If mailing to another church, please provide the church name and mailing address:
- Church Name Please enter valid data.
- Address Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Authorization to Release Information
- I certify that I have read the above information and that I am requesting my own certificate or that of my minor child.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
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Baptismal Certificate Request Form

Authorization to Release Information