Please print out and complete this form and mail it with your payment (see
research fee schedule) to: :
504
Rte 9 N.,
Date of request_________________
Name_________________________________________________
Member??______________Yes ______________No
Address_______________________________________________
_______________________________________________
Email_________________________________________________
Subject of Research Inquiry
Name______________________________________________________________
Date Born_____________________ Where_______________________________
Married_______________________ Where_______________________________
Died__________________________ Where_______________________________
Father’s Name_______________________________________________________
Mother’s Name______________________________________________________
Spouse’s (Maiden) Name______________________________________________
Subject’s Children (Please list all known)
______________________________________________________________________
Subject’s Siblings
______________________________________________________________________
Information Requested (For example: Birth date, date of death, ancestry, birth place, military record, marriage date, parents, spouse, etc.)
________________________________________________________________
Other sources or information already searched:
________________________________________________________________
________________________________________________________________