ST. THOMAS SYRO-MALABAR CATHOLIC OF CHICAGO Application for Dispensation/Permission (Please type or print the appropriate information)

Legal Name of Catholic Party Legal Name of Catholic/Non-Catholic Party

Parish (if catholic)Denomination(if non-catholic) Religion (if non-Christian)

Address Address

A DISPENSATION is respectfully requested from the matrimonial impediment of:

0 Disparity of Cult 0 Affinity (Describe relationship between the parties) 0 0 Other (specify) (Describe the relationship) (eg., , adoption, spiritual relationship, etc.,)

PERMISSION is respectfully requested for:

0 Mixed (If both the parties are baptized Christians, but only one is Catholic) (Proof of and free status of the non-Catholic parties are to be submitted)

Canonical reasons for this dispensation/permission:

____ Spiritual welfare of the faithful ____ Well-founded hope that the non-Catholic will enter with the Church ____ Danger of attempted invalid marriage ____ Convalidation ____ Other (Specify)

PROMISES to be made by the Catholic party for all involving a non-Catholic:

I reaffirm my faith in Jesus Christ and, with God' s help, intend to continue living that faith in the .

I promise to do all in my power to share the faith I have received with our children by having them baptized and reared as Catholics.

Signature of the Catholic Party Date

P.T.O Certification of Priest

The required declaration and promise have been made by the catholic in my presence. The non-catholic has been informed of the Catholic's declaration and promise.

Signature of the Pastor (Seal) Date

FOR CHANCERY USE ONLY

Prot. No ......

Name of Catholic Party

and

Name of Catholic/non-Catholic/non-Christian Party are hereby granted:

____ A DISPENSATION, in virtue of CCEO 795, from the matrimonial impediment of:

_____ PERMISSION, in virtue of CCEO canon 814, for a marriage of mixed religion.

Ordinary/ Delegate of the Ordinary

Date

Specifications if any: