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1000 Pinebrook Road, Venice, FL 34285

(941) 484-9543

contactus@dioceseofvenice.org

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Diaconate Personal Data

Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Phone

Cell Phone

SSN

Date of Birth

Wife's Name

Wife's Date of Birth

Wedding Anniversary Date

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Diocese of Ordination

Date of Ordination

Ordaining Bishop

Diocese of Incardination

Date of Incardination

Employer

Address

Status? Please check all that apply

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Faculties

Preaching

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Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Secondary Telephone for this address (if applicable)

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Assignment(s)

Location

Pastor/Supervisor

Emergency Contact/Relationship/Phone Number

Educational Background

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Doctorate

Military Branch, if applicable

Rank

Number of Years Served

Service period

Description of Prior Employment (List years, position, firm and the tasks required of the position)

Description of Prior Diaconate Ministry

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