KEUSKUPAN AGUNG MEDAN

PAROKI ST. JOSEPH TEBING TINGGI

Alamat : Jl. Pahlawan No. 13. Tebing Tinggi. Sumatera Utara. 20633
Telp. (0621) 21396 / 0821 6519 1468. Email : stjosephtebingtinggi@gmail.com

Format 21.
FORMAT PENDAFTARAN SAKRAMEN PENGUATAN
1. Nama Baptis / Pelindung : .......................................................................... L / P ..................

2. Nama Sendiri (sesuai Akta Lahir) : ........................................................................................................

3. Tempat / Tanggal Lahir : ...........................................................................Usia ............. Thn

4. Nama Lengkap Ayah : ........................................................................................................

5. Nama Lengkap Ibu : ........................................................................................................

6. Tempat / Paroki Baptis : ........................................................................................................

: Buku ............ Hal ............ Nomor ..................

7. Tanggal Baptis : ........................................................................................................

8. Alamat Lengkap : ........................................................................................................

........................................................................................................

9. No. HP : ........................................................................................................

10. Stasi / Lingkungan : ........................................................................................................

Paroki ............................................................................................

No. Kartu Keluarga Katolik ............................................................

Khusus yang masih sekolah / kuliah

Nama Sekolah / Perguruan Tinggi : ........................................................................................................

Kelas / Tingkat : ........................................................................................................

Ketua Stasi / Lingkungan, Calon Penerima Sakramen Penguatan

( ...................................................... ) ( ...................................................... )

Diisi oleh Petugas Sekretariat Paroki

Sakramen Penguatan pada tanggal .......................................... oleh ............................................................

Di Gereja ....................................................................................... Kota ........................................................

( ................................................................ )