Genealogy Information Form

Please complete and submit this form for each individual for which you have information. We will incorporate this data into the genealogy database as soon as possible. Indicate dates as precisely as known (ie: about 1903, 23 Jan 1955, etc.). Provide place locations as precisely as possible, including city, county or township, state or province, and country. Enter names completely as <first name> <middle name(s)> <surname>, <suffixes>, like "Joseph Thomas Bishop, III". Include nicknames in "Other Information".

Your name:

Your E-mail address:

Your Phone number:

Your Address:

Name of the person about whom you are providing information:

Date of birth (dd mmm yyyy or mm/dd/yyyy):

Place of birth (city, county or township, state or province, country):


Date of death:

Place of death:


Father (ex: Joseph Thomas Bishop, Jr. - b. 1831, d. 1885):

Mother (ex: Edna Mary Johnson - b. abt. 1834, d. age 55):



Married (dd mm yyyy, city, county, state, country):


Children (name, date of birth, etc.):

Other Information (nicknames, education, occupation, medical, etc.):

Last known address (phone, fax, email, etc.)

Any other message you would like to provide:

For spam prevention:

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