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 1.
FORMAT PERMOHONAN BAPTIS BAYI / ANAK
DATA CALON BAPTIS

1. Nama Baptis / Pelindung : .......................................................................... L / P ..................

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

3. Tempat / Tanggal Lahir : ........................................................................................................

4. Rencana Pembaptisan : ........................................................................................................

DATA ORANGTUA KANDUNG / ADOPSI (lengkap dengan nama baptis)

1. Nama Ayah : ........................................................................................................

2. Agama Ayah : ........................................................................................................

3. Nama Ibu : ........................................................................................................

4. Agama Ibu : ........................................................................................................

5. Alamat : ........................................................................................................

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

6. No. HP : ........................................................................................................

7. No. Kartu Keluarga Katolik : ........................................................................................................

DATA BAPAK DAN IBU BAPTIS (lengkap dengan nama baptis)

1. Nama Lengkap Bapak Baptis : ........................................................................................................

2. Nama Lengkap Ibu Baptis : ........................................................................................................

3. Stasi / Lingkungan : ........................................................................................................

Paroki : ........................................................................................................

........................................... , ....................................

Ayah Ibu

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

Mengetahui,

Ketua Stasi / Lingkungan Seksi Katekese Stasi / Lingkungan

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

Diisi oleh Petugas Sekretariat Paroki

Dibaptis pada tanggal .............................................. oleh ..............................................................................

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

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