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Address 3:

  
 

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Zip Code:

 
 

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The following information is about:  me  my parents  my grandparents Other - Please Describe Below

Other:

 

FATHER
Father's Full Name
     

(first - middle - last)

 
  Day Month Year City/Town/Place County/Parish/Cemetery Name State and/or Country
Father's Birthdate:
Father's Marriage Date:
Father's Death Date:
Father's Burial Date:
NOTE:  (for date, please use FULL year EX: 1902) Father belonged to which church?
Military? «--- (YES/NO & Branch)
(Served When) ---»
Places LIved
Occupations
list as many as you like with commas please
Name of Father's Father
 		 Name of Father's Mother
(Use birth Name)
(first & middle only if last name the same)       (first, middle, last)
Names of Other Wives
please list marriage date(s) if you have it
             

 

MOTHER
Mother's Full Name
     

(first - middle - last)

 
  Day Month Year City/Town/Place County/Parish/Cemetery Name State and/or Country
Mother's Birthdate:
Mother's Marriage Date:
Mother's Death Date:
Mother's Burial Date:
NOTE:  (for date, please use FULL year EX: 1902) Father belonged to which church?
Military? «--- (YES/NO & Branch)
(Served When) ---»
Places LIved
Occupations
list as many as you like with commas please
Name of Mother's Father
 		 Name of Mother's Mother
(Use birth Name)
(first & middle only if last name the same)       (first, middle, last)
Names of Other Husbands
please list marriage date(s) if you have it
             

 

 

CHILD # 1
Child # 1- Full Name

Male, Female or Unknown
(use "?" for unknown)

 

(first - middle - last)

 
  Day Month Year City/Town/Place County/Parish State and/or Country
Birthdate:
Marriage Date:
Death Date:
Burial Date:
NOTE:  (for date, please use FULL year EX: 1902)    
Child # 1- Spouse
Use Maiden Name if Applicable
  Full Name - First, Middle, Last
             

 

CHILD # 2
Child # 2- Full Name

Male, Female or Unknown
(use "?" for unknown)

 

(first - middle - last)

 
  Day Month Year City/Town/Place County/Parish State and/or Country
Birthdate:
Marriage Date:
Death Date:
Burial Date:
NOTE:  (for date, please use FULL year EX: 1902)    
Child # 2- Spouse
Use Maiden Name if Applicable
  Full Name - First, Middle, Last
             

 

CHILD # 3
Child # 3- Full Name

Male, Female or Unknown
(use "?" for unknown)

 

(first - middle - last)

 
  Day Month Year City/Town/Place County/Parish State and/or Country
Birthdate:
Marriage Date:
Death Date:
Burial Date:
NOTE:  (for date, please use FULL year EX: 1902)    
Child # 3- Spouse
Use Maiden Name if Applicable
  Full Name - First, Middle, Last
             

 

CHILD # 4
Child # 4- Full Name

Male, Female or Unknown
(use "?" for unknown)

 

(first - middle - last)

 
  Day Month Year City/Town/Place County/Parish State and/or Country
Birthdate:
Marriage Date:
Death Date:
Burial Date:
NOTE:  (for date, please use FULL year EX: 1902)    
Child # 4- Spouse
Use Maiden Name if Applicable
  Full Name - First, Middle, Last
             

 

CHILD # 5
Child # 5- Full Name

Male, Female or Unknown
(use "?" for unknown)

 

(first - middle - last)

 
  Day Month Year City/Town/Place County/Parish State and/or Country
Birthdate:
Marriage Date:
Death Date:
Burial Date:
NOTE:  (for date, please use FULL year EX: 1902)    
Child # 5- Spouse
Use Maiden Name if Applicable
  Full Name - First, Middle, Last
             

 

CHILD # 6
Child # 6- Full Name

Male, Female or Unknown
(use "?" for unknown)

 

(first - middle - last)

 
  Day Month Year City/Town/Place County/Parish State and/or Country
Birthdate:
Marriage Date:
Death Date:
Burial Date:
NOTE:  (for date, please use FULL year EX: 1902)    
Child # 6- Spouse
Use Maiden Name if Applicable
  Full Name - First, Middle, Last
             

 

CHILD # 7
Child # 7- Full Name

Male, Female or Unknown
(use "?" for unknown)

 

(first - middle - last)

 
  Day Month Year City/Town/Place County/Parish State and/or Country
Birthdate:
Marriage Date:
Death Date:
Burial Date:
NOTE:  (for date, please use FULL year EX: 1902)    
Child # 7- Spouse
Use Maiden Name if Applicable
  Full Name - First, Middle, Last
             

 

CHILD # 8
Child # 8- Full Name

Male, Female or Unknown
(use "?" for unknown)

 

(first - middle - last)

 
  Day Month Year City/Town/Place County/Parish State and/or Country
Birthdate:
Marriage Date:
Death Date:
Burial Date:
NOTE:  (for date, please use FULL year EX: 1902)    
Child # 8- Spouse
Use Maiden Name if Applicable

  Full Name - First, Middle, Last
             

 

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By using this form, you are allowing me to put this data in the Douglas Archives.
My thanks go to Lawrence J. Lachance for his permission to adapt his form.
 

 

 
This page was last updated on 11 August 2021

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