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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)

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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

Year Round

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Faculties

Preaching

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

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Assignment(s)

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Pastor/Supervisor

Emergency Contact/Relationship/Phone Number

Educational Background

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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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