St. Joseph Catholic Church

IGLESIA CATÓLICA SAN JOSE

218 E. 12th Street
Los Angeles, CA 90015

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CONFIRMATION / CONFIRMACION

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  RECEIVED CONFIRMATION AT: 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.
  
  DATE OF CONFIRMATION (If not sure, isert an approximate) REQUIRED Please fill out this field. Please enter a date.
  
  BIRTH FATHER'S INFORMATION:
  
  FATHER'S FIRST NAME: REQUIRED Please fill out this field. Please enter valid data.
  
  FATHER'S LAST NAME REQUIRED Please fill out this field. Please enter valid data.
  
  MOTHER'S INFORMATION (PROVIDE MAIDEN NAME):
  
  MOTHER'S FIRST NAME REQUIRED Please fill out this field. Please enter valid data.
  
  MOTHER'S MAIDEN LAST NAME REQUIRED Please fill out this field. Please enter valid data.
  
  WHO IS REQUESTING THIS CERTIFICATE? (PROVIDE CONTACT INFORMATION AND MAILING ADDRESS WHERE WE WILL MAIL THE CERTIFICATE)
  
  REQUESTED BY (FIRST AND LAST NAME) 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.
  
  ADDRESS: REQUIRED Please fill out this field. Please enter valid data.
  
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  COMMENTS: REQUIRED Please fill out this field.
  
  UPON SUBMISSION YOU WILL BE REDIRECTED TO A PAGE WHERE YOU WILL COMPLETE THE REQUIRED PAYMENT OF $30.OO PER CERTIFICATE. PLEASE KEEP IN MIND THERE IS NO REFUND. IF YOU ARE NOT SURE YOU RECEIVED THE SACRAMENT AT OUR PARISH DO NOT MAKE THE PAYMENT UNTIL WE CONTACT YOU. CERTIFICATES ARE PREPARED IN THE ORDER WE RECEIVE THEM. IT CAN TAKE UP TO FOUR WEEKS TO RECEIVE YOUR CERTIFICATE. AFTER FOUR WEEKS IF YOU HAVE NOT RECEIVED YOUR CERTIFICATE, PLEASE CONTACT OUR OFFICE.
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