Genealogy Research Data Form - Maine Irish Heritage Center

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Genealogy Research Data Form
Please complete all of the fields that you are able to. Any information that you may have about your
family background can be instrumental in yielding better results for your search.
Your contact Information:
Name and phone number: ____________________________________________________________
E Mail: ____________________________________________________________________________
The ancestors that you are most interested in learning about (Paternal, Maternal, Both, Specific
Request)
Your Name and Birthplace: ___________________________________________________________
Your Father’s Name:_____________________________________ DOB: ________________________
Place of Birth: ____________________________ Lived In: ___________________________________
Date of Death:_____________________________Place of Death: _____________________________
Your Mother’s Name: ___________________________________DOB:_________________________
Place of Birth:_____________________________Lived In:___________________________________
Date of Death:_____________________________ Place of Death:_____________________________
Maternal Grandmother’s Name: _________________________________DOB:___________________
Place of Birth:_____________________________Lived In:___________________________________
Date of Death:______________________________Place of Death:____________________________

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