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:
(Example: Birth date, date of death, ancestry, birth place, military record,
marriage date, parents, spouse, etc.)
________________________________________________________________
Other sources or information already searched:
________________________________________________________________
________________________________________________________________