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PARISH LETTERHEAD

M. Form No. 2A

____________________________
____________________________
____________________________

Dear Rev. Fr. ____________________________:


We, Mr.______________________________________________Status: ____________________
Date of Birth: __________________________ Place: ___________________________________
Present Residence: ______________________________________________________________
Parish of: ______________________________________________________________________

and Miss ____________________________________________ Status: ____________________


Date of Birth: __________________________ Place: ___________________________________
Present Residence: ______________________________________________________________
Parish of: ______________________________________________________________________

desire to marry in this Church as soon as possible. Therefore, we humbly ask your good office for
dispensation from ( ) one ( ) two Publication/s of the Banns. We hereby state under our honor
that we are both in free state to marry each other.
The reason/s for the dispensation is/are: ___________________________________________

______________________________________________________________________________.

With profoundest sentiments of filial respect, we beg to remain

Your humble Children in Christ,

___________________________ ___________________________
Male Contracting Party Female Contracting Party
______________________________________________________________________________
ENDORSEMENT OF THE PARISH PRIEST:
The undersigned Parish Priest, after having interviewed the contracting parties, in accordance
with C. 1066, hereby testify that I have found no impediment to this marriage. For this reason, I
favorably endorse the petition of:

________________________________and ________________________________ for the


reasons which they have adduced.

_______________________________________ __________________
Signature over Printed Name of Parish Priest Date

Updated: 11/2019

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