APPENDIX D

SACRAMENTAL REQUEST FORM

AUTHORIZATION FOR RELEASE OF INFORMATION RECORDS FROM SACRAMENTAL RECORDS

I agree to hold harmless the Diocese of St. Petersburg, the Roman Catholic Church, its Dioceses, Bishops and there successors in office, the aforesaid parish and all other persons connected with them from any liability for releasing this information pursuant to my request.

A COPY OF PHOTO IDENTIFICATION
MUST ACCOMPANY THIS REQUEST

Note: The person authorizing release must be the person named in the record,
the parent of a minor child, or the spouse or adult child if the person is deceased.
Anyone else must show proof of power of attorney.