Name of individual being researched:
Please provide all pertinent information you have concerning this individual. For example: names of spouse(s), names of children, names of parents, dates and locations of birth, marriage, death; location(s); date of immigration; etc:
Please state the specific question you wish answered or your general research request:
Please cite the sources you have already searched
(to prevent duplication of efforts):
Additional comments:
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First Name:
Middle Initial/Name:
Last Name:
Mailing Address:
City:
State/Province: (US/CAN)
Zip/Postal Code:
Country:
Email Address:
Telephone (inc. area code)
Communication Preference (email or phone):
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