Subject:
1. Name: _____________________/_______________________/______________________
                          first                                       middle                                        last
               ____________________________ __________________
                additional names and nicknames            Jr., Sr., II, III, etc

2. Birth date: ______/______/________

3. Birth place: _____________________ ________________          4. Gender: M/F
                           city        state                                                                   circle one
5. Generation: _____________________ 6. Genealogical Number: ___________________

7. Death date: ______/______/________

8. Place of death: _____________________ _________________ 9. Burial place: _______________
                                           city                                 state
Subject's parents:
10. Mother: _____________________/_______________________/___________________
                                   first                                 middle                                        last
11. Father: _____________________/_______________________/___________________
                                   first                                 middle                                        last
                    ____________________________      __________________
                        additional names and nicknames            Jr., Sr., II, III, etc
Subject's spouse:
12. Name: _____________________/_______________________/__________________
                               first                                middle                                           last
13.Birth date: ______/______/________

14. Birth place: _____________________ ________________            15. Gender: M/F
                                          city                              state                                  circle one

16. Marriage date: ______/______/________

17. Place of marriage:____________/_________________/______________
                                       church                  city                                 state

18. Death date: ______/______/________

19. Place of death: __________________ _________________ 20. Burial place: ______________
                                            city                                state
21. Divorce (if applicable) ______/______/________ _________________/______________
                                                     date                                         city                         state
Subject spouse's parents:
22. Mother: _____________________/_______________________/___________________
                                  first                                 middle                                            last

23. Father: _____________________/_______________________/___________________
                                  first                                middle                                              last
                     ____________________________ __________________
                         additional names and nicknames          Jr., Sr., II, III, etc

Subject's children:
                    first           middle                                    city                      state                  month/day/year
a.__________________________________ _____________________________ ______/_____/____

b.__________________________________ _____________________________ ______/_____/____

c.__________________________________ _____________________________ ______/_____/____

d.__________________________________ _____________________________ ______/_____/____

e.__________________________________ _____________________________ ______/_____/____

On additional paper, please include information on additional marriages. Include all data available listed on items 12 through 21, above.
Please include on an additional piece of paper, a brief biographical sketch limited to 200 words (more than 200 will be edited). Include such things as place(s) of residence, occupation(s), and work history, military service, sports, hobbies, church affiliation(s), political activities, fraternal, service, and professional organizations, anecdotes, adventures, awards and achievements.

Compiler:
Name:_____________________________ Address___________________________________________

Phone:_(_____)___________________FAX__________________e-mail__________________________

Date:________/___________/________

OPTIONAL INFORMATION Sources:
2&3 _______________________________           7&9 _________________________________

10 & 11 ____________________________           12 ___________________________________

13 & 14 ____________________________           16 &17 _______________________________

18 thru 20____________________________         21 ___________________________________