GENEALOGY INQUIRY FORM

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YOUR NAME (Last, First Middle)*

Email Address*

Your DOB or Year of Birth - Optional but would help (mm/dd/yyyy)

Location of Birth (City, County, State)

MOTHER'S Name (MAIDEN, First Middle)

Mother's DOB

Mother's Location of Birth (City, County, State)

Mother Living?

YesNo - please provide DOD

Mother's DOD

Mother's Location of Death (City, County, State)

FATHER'S Name (Last, First Middle)

Father's DOB

Father's Location of Birth (City, County, State)

Father Living?

YesNo, please provide DOD

Father's DOD

Father's Location of Death (City, County, State)

Siblings? On a single line for eash, please List LAST, First Middle*

I AM WRITING TO FIND OUT (Select from list)

I am seeking information on (list LAST, First Middle - DOB/DOD)

I have information to share with you.

YesNo

Would you like to speak with us?

Yes, please call me as I've indicated belowNo thanks. I'd prefer to communicate by email

Phone number (AC-###-####)

If you'd like us to call you, please tell us what time would be best.

What day would be best for us to call you.

What's your email address?

Do you have a website? If so, please enter your URL address here:

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Thank you! Your information has been submitted successfully. We'll answer you inquiry as quickly as possible. Dave and Marie Eckard