Click here for a printable version of this form that you may submit by mail. "*" indicates required fields Name* Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last Suffix Years of Service* 5 years (started in 2020) 10 years (started in 2015) 15 years (started in 2010) 20 years (started in 2005) 25 years (started in 2000) 30 years (started in 1995) Over 30 years Other Please provide the number of years and the year started.*____ years (for over 30 years) ____ (year started)Served at the following parishes:*Parish Name, CityTitle Add RemoveCurrent Parish*All Saints Parish, ClearwaterBlessed Sacrament Parish, SeminoleBlessed Sacrament Parish, TampaBlessed Trinity Parish, St. PetersburgCathedral of St. Jude the Apostle, St. PetersburgChrist the King Parish, TampaCorpus Christi Parish, Temple TerraceEpiphany of Our Lord Parish, TampaEspiritu Santo Parish, Safety HarborHoly Cross Parish, St. PetersburgHoly Family Parish, St. PetersburgHoly Martyrs of Vietnam Parish, St. PetersburgImmaculate Conception Haitian Mission, TampaIncarnation Parish, TampaLight of Christ Parish, ClearwaterMary Help of Christians Center, TampaMercy of God Polish Mission, St. PetersburgMost Holy Name of Jesus Parish, GulfportMost Holy Redeemer Parish, TampaNativity Parish, BrandonOur Lady of Fatima Parish, InvernessOur Lady of Grace Parish, Beverly HillsOur Lady of Guadalupe Mission, WimaumaOur Lady of Lourdes Parish, DunedinOur Lady of Perpetual Help Parish, TampaOur Lady of the Rosary Parish, Land O'LakesOur Lady Queen of Peace Parish, New Port RicheyPrince of Peace Parish, Sun City CenterResurrection Parish, RiverviewSacred Heart Parish, Dade CitySacred Heart Parish, Pinellas ParkSacred Heart Parish, TampaSan Juan Diego Mission, DoverSt. Anne Parish, Ridge ManorSt. Anne Parish, RuskinSt. Anthony of Padua Parish, San AntonioSt. Anthony the Abbot Parish, BrooksvilleSt. Benedict Parish, Crystal RiverSt. Brendan Parish, ClearwaterSt. Catherine of Siena Parish, ClearwaterSt. Cecelia Parish, ClearwaterSt. Clement Parish, Plant CitySt. Elizabeth Ann Seton Parish, Citrus SpringsSt. Frances Xavier Cabrini Parish, Spring HillSt. Francis of Assisi Parish, SeffnerSt. Ignatius of Antioch Parish, Tarpon SpringsSt. James the Apostle Parish, Port RicheySt. Jerome Parish, LargoSt. Joan of Arc Parish, Spring HillSt. John Vianney Parish, St. Pete BeachSt. Joseph Parish, St. PetersburgSt. Joseph Parish, TampaSt. Joseph Parish, ZephyrhillsSt. Joseph Vietnamese Mission, TampaSt. Justin Martyr Parish, SeminoleSt. Lawrence Parish, TampaSt. Luke the Evangelist Parish, Palm HarborSt. Mark the Evangelist Parish, TampaSt. Mary Parish, TampaSt. Mary, Our Lady of Grace Parish, St. PetersburgSt. Mary, Our Lady of Sorrows Parish, MasaryktownSt. Matthew Parish, LargoSt. Michael the Archangel Parish, ClearwaterSt. Michael the Archangel Parish, HudsonSt. Patrick Parish, LargoSt. Patrick Parish, TampaSt. Paul Parish, St. PetersburgSt. Paul Parish, TampaSt. Peter Claver Parish, TampaSt. Peter the Apostle Parish, TrinitySt. Raphael Parish, St. PetersburgSt. Rita Parish, Dade CitySt. Scholastica Parish, LecantoSt. Stephen Parish, RiverviewSt. Theresa Parish, Spring HillSt. Thomas Aquinas Parish, New Port RicheySt. Thomas the Apostle Parish, HomosassaSt. Timothy Parish, LutzSt. Vincent de Paul Parish, HolidayUSF Catholic Student Center, TampaCurrent title* Δ
