GENEAOLOGY SUBMISSION FORM

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Please help to improve my geneaology information. I try to be as accurate as possible. if you have new information to add or corrections to current information, please submit the information below.
Name: Title (Jr., II, Ph.D.): Sex:

Date of Birth (00 Xxx 0000): Place of Birth (City, County, State):

Date of Death (00 Xxx 0000): Place of Death (City, County, State):

Burial Place:

Additional Information (Retirement, Adoption, Baptism, Graduation, etc.)

Event #1: Date: Place:

Event #2: Date: Place:

Event #3: Date: Place:

Event #4: Date: Place:
Spouse: Title (Jr., II, Ph.D.): Sex:

Date of Birth (00 Xxx 0000): Place of Birth (City, County, State):

Date of Death (00 Xxx 0000): Place of Death (City, County, State):

Burial Place:
Child #1: Sex:

Date of Birth (00 Xxx 0000): Place of Birth (City, County, State):

Date of Death (00 Xxx 0000): Place of Death (City, County, State):

Burial Place:

Child #2: Sex:

Date of Birth (00 Xxx 0000): Place of Birth (City, County, State):

Date of Death (00 Xxx 0000): Place of Death (City, County, State):

Burial Place:

Child #3: Sex:

Date of Birth (00 Xxx 0000): Place of Birth (City, County, State):

Date of Death (00 Xxx 0000): Place of Death (City, County, State):

Burial Place:

Child #4: Sex:

Date of Birth (00 Xxx 0000): Place of Birth (City, County, State):

Date of Death (00 Xxx 0000): Place of Death (City, County, State):

Burial Place:

If you have information on several genertations of a family line or additional information which you cannot submit on this form, it may be easier to email the information to wgalentine@hotmail.com

Thank you for your time and information. If I can be of any assistance to you, please let me know.