Fitchburg Historical Society
GENEALOGY RESEARCH REQUEST FORM
This is a two page form. Please print this form and fill it out. The more information you provide, the easier and more successful our search will be. Then mail this form to the Fitchburg Historical Society, 50 Grove St., P.O. Box 953, Fitchburg, MA 01420.
Date _______________
Name _________________________________________
Address _______________________________________
City ______________________ State _________ Zip ________________
Tel. ________________________ Fax ___________________________
Email ________________________________________________________
I, _______________________, have read the Fitchburg Historical Society Research
(Name)
Policy and I agree to pay the fees as outlined up to a limit of ____ hours or $ ________.
_______________________________________
(Signature)
Please describe the detailed family information on the Page 2. Then describe the research
request here. ___________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Fill in as much information as possible.
Page 2
Fitchburg Historical Society
GENEALOGY RESEARCH REQUEST FORM
Family Name ________________________________________________________
First Name ___________________________________________________________
Born ___________ in _________________________________________________
Died ___________ in _________________________________________________
Buried _________ in cemetery in _______________________________________
Married _________ in __________________________________________________
To ___________________________________________________________________
Parent’s Name __________________________________________________________
Who was born __________ in ____________________________________________
Died __________________ in ____________________________________________
Buried in ______________ in cemetery in __________________________________
Other parent’s name ______________________________________________________
Who was born __________ in ____________________________________________
Died __________________ in ____________________________________________
Buried in ______________ in cemetery in __________________________________
Children
Name Date of Birth Place of Birth Death
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________