Saint Gertrude Parish

9613 Schiller Blvd

Franklin Park, IL 60131 (847) 455-1100

Affidavit for Admission to the Roman Catholic Church

Currently enrolled in:
5/4/2011
Date of Request: ____________________________________________________________ x CCD Program RCIA Other
I
Roberto Oliva
M Name of Candidate: ___________________________________________________________________________________ 2/25/1967
Date of Birth: _________________________________
P Chipiona
Place of Birth: _____________________________________________ Sacrament Received: Baptism x 3/25/2000
Other Date:_________________________________
O Fulanito Rodríguez
Father’s Name: _____________________________________________________________ Menganita Pérez
Mother’s:____________________________________________________________________
R Sultano García
God Parents: ________________________________________________________________ Mengana Suárez
and ___________________________________________________________________________
T San Pedro Apóstol
Name of Church and Address of Baptism: ______________________________________________________________________________________________________________
A San Juan de Dios 222 Bis, Col. Lázaro Cárdenas, Del. Tlalpan, 14370, México D.F. (Mexico)
_________________________________________________________________________________________________________________________________________________________________
N Rev. Enrique Lozada
Minister:__________________________________________________________________________________________ Documentation Received: x Yes No
T

Petition to sign:

I / we ____________________________________________ (relationship): ____________________ request to be admitted

officially in the Catholic Church.

Parents: _________________________________________________ and_________________________________________________

Godparents: ______________________________________________ and_________________________________________________

Approved by:

Rev. Eryk Czarnecki, Pastor Pastor Church Seal