Marriage Permission/dispensation Form
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1
2O
C
S
FFICE OF
ANONICAL
ERVICES
A
W
, P.O. B
29260, W
, DC 20017-0260
RCHDIOCESE OF
ASHINGTON
OX
ASHINGTON
T
: 301.853.5325
F
: 301.853.7674
E-
:
@
.
EL
AX
MAIL
CANONICAL
ADW
ORG
MARRIAGE PERMISSION/DISPENSATION FORM
Bride
: _______________________________________ __Catholic (Rite: __Latin __Eastern)
(full name)
__unbaptized __baptized non-Catholic: denomination__________________________________
_______________________________________________________________________________________________________________________________
Address
_______________________________________________________________________________________________________________________________
City
State
Zip
County
Groom
:
__Catholic (Rite: __Latin __Eastern)
(full name)
_________________________________________________________
__unbaptized __baptized non-Catholic: denomination__________________________________
_______________________________________________________________________________________________________________________________
Address
_______________________________________________________________________________________________________________________________
City
State
Zip
County
_______________________________________________________________________________________________________________________________
Place of Wedding (parish church or other)
City
State
(Diocese)
____________________________________________________________________________________________
Name of Officiant
Relationship to Couple
______________________________________________________________________________________________________
Officiant’s Religious Denomination or Civil Status
Date of Wedding
CERTIFICATION OF CATHOLIC PRIEST/DEACON
The required declaration and promise have been made by the Catholic party in my presence. The
non-Catholic party has been informed of this requirement so that it is certain that he/she is aware of the
promise and obligation on the part of the Catholic party.
Signature of Catholic Priest/Deacon____________________________________ Date_______________
Church___________________________________________ Tel:______________ Fax:______________
Address___________________________________________ E-mail:_____________________________
City______________________________________________ State__________
Zip_______________
Note: Please notify the Office of Canonical Services if wedding is cancelled.
For Office of Canonical Services Use:
Permission/Dispensation granted: ____Mixed Religion ____Disparity of Cult ____Canonical Form
Other_______________
____(Ad Cautelam)
Delegate of the Archbishop___________________________________________ Date_______________
Revised 08/2012
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