MARRIAGE DISPENSATION REQUEST Diocese of Toledo Office of the Bishop 1933 Spielbusch Ave. Toledo, Ohio 43604-5360 Date ___________________________________ 20______ Marriage Information _______________________________________ Catholic, Priest/Deacon ____________________________________ Name, if woman, maiden name residing in _____________________________________ Parish City Parish ___________________________________________ wishing to marry _______________________________________________ Address _________________________________________ Name, if woman, maiden name Denomination (if Catholic _____________________________________) City _________________________ Zip ________________ Parish City PLEASE CHECK ONE OF THE FOLLOWING: MAIL TO: Diocese of Toledo Office of the Bishop ❑ Baptized Catholic ❑ Baptized non-Catholic ❑ Non-baptized ❑ Doubtfully baptized 1933 Spielbusch Ave., Toledo, Ohio 43604-5360 PRE-NUPTIAL DECLARATION AND PROMISE (Promise must be made in every marriage involving a non-Catholic, or one who has left the church by a formal act.) By the Catholic Party: I reaffirm my faith in Jesus Christ, and with God’s help, intend to continue living that faith in the Catholic Church. At the same time I acknowledge the respect I owe to the conscience of my partner in marriage. I promise to do all that I can to share the faith I have received with our children and to make every effort that I can to have them baptized and reared as Catholics. ___________________________________________ Signature of Catholic Party ___________________________________________ ___________________________________________ Signature of Priest/Deacon City Date Dispensation Requested: ____ Dispensation from disparity of worship for a mixed marriage between a Catholic and a non-baptized person (Disparity of Cult) ____ A precautionary dispensation from disparity of worship and a permission for mixed religion for a marriage between a Catholic and a doubtfully baptized member of another Christian Church. ____ Dispensation from Canonical Form is also requested to contract the marriage with the above party of another faith. The marriage will take place at: _______________________________ Church, __________________ (City), ______(State) on ________________ (date) in the presence of _________________________(title) ___________ The reasons for requesting this dispensation are:_____________________________________________________ _______________________________________________________________________________________________ ____ Other (please specify) ___________________________________________________________________________ Reasons for this Request Are: ____ Validation of marriage before a civil magistrate/minister ____ Spiritual well being of the parties ____ Well established hope/promise for the non-Catholic party to convert ____ Danger of a civil marriage ____ Dangerous familiarity/incontinence or loss of reputation ____ Hope of conversion of non-Catholic party of Woman The above dispensation(s) is(are) granted _________________________________________________________________ Date Protocol number By ______________________________________________________________________________ Delegate of the Bishop 9.2012.