One Eagle Rock Ave., West Orange, NJ 07052-5040 - Phone: 973.325.0110

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Sacrament Certificate Request

Need a copy of your Baptismal, Confirmation or Marriage Certificate or full Sacramental Record?
Please fill out the form below.
A $10 processing fee is requested and will cover multiple certificates if you require more than one. Please allow 7 business days to receive your certificate. Please make check payable to Our Lady of Lourdes.

PLEASE NOTE: You will need to provide at least the year in which the event took place.

If you cannot complete this form, please call the rectory office at 973-325-0110, Monday - Friday between 9am and 2pm.

PLEASE ENTER ALL RELEVANT INFORMATION

I need a copy of a *

Baptism Certificate

Confirmation Certificate

Marriage Certificate

Certificate is for *

Myself

Someone Else

Person making request (First and Last Name) *

Mailing Street Address *

City, State, Zip *

Your email address *

Your Phone (in case we have questions) *

Enter Any/All information pertinent to the person for whom the certificate is requested.

Name (First, Middle, Last) *

Date of Birth *

Father's Name (First and Last) *

Mother's Name (First and Maiden) *

Year of Baptism

Year of Confirmation

Wedding Date (Month, Day, Year)

Special Instructions

Once the certificate is ready

I will pick up the certificate at the rectory

Please mail the certificate to me

Message

OUR LADY OF LOURDES R.C. CHURCH

sanctuary

One Eagle Rock Avenue
West Orange, NJ 07052-5040
Phone: 973.325.0110
FAX 973.325.9105
E-MAIL: OLLWONJ@VERIZON.NET

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