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Certificate Request

- Our Parish

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- Parish REQUIRED Please fill out this field.
- Sacrament REQUIRED Please fill out this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Approximate date of Sacrament REQUIRED Please fill out this field. Please enter valid data.
- Father's Name REQUIRED Please fill out this field. Please enter valid data.
- Mother's Maiden Name REQUIRED Please fill out this field. Please enter valid data.
- Name of Person Requesting REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- There's a $10.00 fee per certificate. To process payment online please click the link below. | El costo de $10.00 por certificado. Para hacer su pago en line haz clic en el enlace abajo.
  https://saolv.churchgiving.com/ws/opportunities/CertificatesDonations
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Saint Augustine-Our Lady of Victory

Roman Catholic Church

Certificate Request