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Submitter's Name
 
Submitter's Address
 
Submitter's City, State, Zip
 
Submitter's Telephone #
 
Submitter's E-Mail Address
  
Submitter's Source 1
  
Submitter's Source 2
  
Submitter's Source 3

Submitters Notes/Comments

HUSBAND'S NAME          
When Borni.e. 10 May 1881
Where BornCounty, City, ST
When Died i.e. 21 June 1920
Where DiedCounty, City, ST
When Buriedi.e. 11September 1936
Where BuriedCemetery, County, City, ST
When Marriedi.e. 12 October 1913
Where MarriedCounty, City, ST
Other Wives(ifany)Number(1)(2)(3), etc.

His Father
His Mother's Maiden Name

WIFE'S MAIDEN NAME
When Borni.e. 01 January 1900
Where BornCounty, City, ST
When Diedi.e.  02 February 1902
Where DiedCounty, City, ST
When Buriedi.e. 10 March 1910
Where BuriedCemetery, County, City, ST
Other Husbands(ifany)Number(1)(2)(3),etc.
Her Father
Her Mother's Maiden Name

 

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Date___________________________
Compiler_______________________
Address_________________________
City____________________
_______________________

 

 

 

Male
or
Female

CHILDREN
(Arrange in order of birth)

WHEN BORN
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Day Month Year

WHERE BORN
Town or place County

State or Country

WHEN DIED
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Day Month Year

Marriage(s)
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To
M F 2. Date
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M F 3. Date
To
M F 4. Date
To
M F 5. Date
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M F 6. Date
To
M F 7. Date
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M F 8. Date
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M F 9. Date
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M F 10. Date
To
M F 11. Date
To
M F 12. Date
To

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