Request Genealogical Research – Luzerne County Historical Society

Applicants Name*

Applicants Address*

Applicants Email*

Applicants Phone

Is Delivery Address The Same As Above?*

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Delivery Address

Deliver to Name

Deliver to Address

Deliver to Email

Deliver to Phone

Ancestor To Be Searched

Ancestor's Name*

First Middle Last

Please Include Middle Initial

Ancestor's Maiden Name (If Applicable)

Ancestors Birth Date

Ancestors Birth Location

Ancestors Marriage Date

Ancestors Marriage Location

Ancestors Death Date

Ancestors Death Location

Ancestors Years In Luzerne County

Ancestors Town or Township of Residency

Nationality/From

Ancestors Religion

Ancestors Name of Spouse

Ancestors Spouse Birth Date

Ancestors Spouse Birth Location

Ancestors Spouse Death Date

Ancestors Spouse Death Location

What you are looking for?

Did They Have Any Children

Yes

First Child

Name of First Child

First Child Birth Date

First Child Birth Location

First Child Death Date

First Child Death Location

First Child Name of Spouse

Would You Like To Add A Second Child

Yes

Second Child

Name of Second Child

Birth Date of Second Child

Birth Location of Second Child

Death Date of Second Child

Death Location of Second Child

Name of Spouse of Second Child

Would You Like To Add A Third Child

Yes

Third Child

Name of Third Child

Birth Date of Third Child

Birth Location of Third Child

Death Date of Third Child

Death Location of Third Child

Name of Spouse of Third Child

Would You Like To Add A Fourth Child

Yes

Fourth Child

Name of Fourth Child

Birth Date of Fourth Child

Birth Location of Fourth Child

Death Date of Fourth Child

Death Location of Fourth Child

Name of Spouse of Fourth Child

Would You Like To Add A Fifth Child

Yes

Fifth Child

Name of Fifth Child

Birth Date of Fifth Child

Birth Location of Fifth Child

Death Date of Fifth Child

Death Location of Fifth Child

Name of Spouse of Fifth Child

Payment

Are You A Luzerne Member?*

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How would you like the research sent to you?*

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Genealogical Research Form