ECCLESIASTICAL PETITION FOR DISPENSATION AND DECREE OF NULLITY

     I, _____________________________________, do hereby submit to the
Ecclesiastical Jurisdiction of The Most Reverend David Leon Cooper, O.M.M., 
bishop of the Orthodox Catholic Order of the Missionaries of Mercy, 
and plead for Apostolic Dispensation and finding of nullity with regards to
my marriage to _________________________________.  

I submit that the marriage was not valid due to one or more of 
the following reasons:

(Check space(s) that apply)

*Lack of Baptism          HE:  _____     SHE:_____
(at the time of the marriage)

*If one of the parties was not baptized at the time of the marriage, 
did a bishop grant a dispensation for the lack of baptism?

Yes: _________          No: _________

*Check here if you do not know if a dispensation was granted      ___________

*What type of clergy performed the marriage?  

 _____________________________________________
(denomination) (title) (indicate if priest, rabbi, judge, minister, etc)


Intention Against Children         HE:  _____          SHE:_____

Intention Against Permanence       HE:  _____          SHE:_____

Intention Against Fidelity         HE:  _____          SHE:_____

Force and Fear/Reverential Fear    HE:  _____          SHE:_____
(made to marry by force or fear or even fear of being in sin)


Defective Convalidation            HE:  _____          SHE:_____
(no true mutual consent)

Substantial Error                  HE:  _____          SHE:_____
(so many lies or falsehoods about the personhood or character to be highly  deceitful or
fraudulent)

Lack of Due Discretion             HE:  _____          SHE:_____
(did not really take the marriage seriously from the beginning)


Defective Consent                  HE:  _____          SHE:_____
(did not really consent at the time of marriage due to any reason; this could be a mental
problem or simply did not intend it)


Incapacity to Develop a Community of Life and Love     HE:  _____       SHE:_____
(could be such a psychologic, or otherwise emotional defectiveness that cognition of
marital responsibilities were not possible;this is a total inability to comprehend  or
participate in a marital relationship)


Psychic Incapacity Due to:

alcoholism               HE:  _____          SHE:_____

drugs                    HE:  _____          SHE:_____
(could be illicit or abuse of prescribed medication)

homosexuality       HE:  _____          SHE:_____

mental or emotional illness   HE:  _____          SHE:_____

conditions (medical)          HE:  _____          SHE:_____

Provide explanation:




Was there adultery during the marriage?


Yes:  _________          No: _________


Who officiated?
(Priest, minister, civil official, other)

Is spouse still living? 



SOLEMN DECLARATION:

I hereby certify that the above statements are true and accurate to the
best of my knowledge. 

I hereby certify that I have been counseled by the officiating priest that 
I must enter into the sacrament of Holy Matrimony with an especially sincere
and contrite heart so that I do not blaspheme the Holy Spirit.  This is 
Especially true if I am to receive Holy Communion at the Wedding Rite.  I 
further certify that I have examined myself in this regard and will continue
to do so until and including the moment of the reception of the Sacraments.


Date: ____________________


By:  ______________________________________________


Name: _____________________________________________
                    (Please Print)


     Please call our offices at (818) 773-7309 for pricing information. 

     Once you have the pricing information, attach a copy of your civil divorce decree and your check or money order made out to The St. Mary Institute, along with the completed petition and mail to:

          18533 Roscoe Blvd. PMB 195 
          Northridge, CA 91324

     You may also pay the fees by credit card.  Please fill out the following
information:

Credit Card Type:

Credit Card Number:

Expiration Date:

Cardholder Name:

Complete Billing Address:

Telephone Number:

E-mail address (optional):


Annulment fees are refundable only if Bishop Cooper will not grant the
Petition.