Genealogical Submission Form - Chemung County Library District
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2*PLEASE USE A SEPARATE FORM FOR EACH REQUEST*
In order to provide you with an accurate answer, please answer as many of the following questions as you can. Vague or
imprecise queries are likely to remain unanswered. Upon request, we will send you a list of local researchers who, for fee,
may also be able to help you.
Information about you:
Name:
Address:
City:
State:
Zip:
E-mail:
Information about your query:
Is this an obituary request?
Yes
No
Name for query
Birth date:
Birthplace:
Marriage date:
Death date
Where did he/she die?
Where is he/she buried?:
His/her place of residence (please include county, township, and city if possible):
Please write your specific requests in the box below. Include such information as: what kind of information you are
hoping to find, what you already know that might be able to help us in our research, and any other information pertinent
to your request.
After you have completed this form, mail to: Chemung County Library District, Genealogy Dept. 101 E. Church St. Elmira, NY
14901. Or pay online and email form to & submit payment via paypal, note:research query in special instructions
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