Sacramental Certificate Request Form

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To request a sacramental certificate, please complete this form and submit a photo ID to the parish office. Requests must be made in writing. In order to protect the confidentiality of these records, St. Ann Catholic Church can only release sacramental certificates to the individual named on the certificate (or the next of kin if deceased), or to the parents or legal guardian if the named person is under the age of 18.

Saint Ann Catholic Church
4057 US 70 BUS HWY W.
Clayton, NC 27520
(Phone) 919-934-2084 (Fax) 919-934-4639

Name of the person whose certificate is being requested:/ Nombre de la persona cuyo certificado solicita:

Date of Birth:/ Fecha de Nacimiento

YYYY

Requesting:/ Solicitando

Baptismal Certificate/Certificado de Bautismo

First Communion Certificate/Certificado de Primera Comunion

Confirmation Certificate/Certificado de Confirmacion

Marriage Certificate/Acta de Matrimonio

Holy Order/Ordenes Sagradas

Date Sacrament Conferred:/Fecha del Sacramento Conferido

YYYY

Requester's Name /Nombre del Solicitante:

Address/ Direccion

Phone Number/Numero de Telefono

Email Address/Correo Electronico

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