TIPCOA Research Request Form

We charge $10.00 per hour, plus copies and postage.

Please fill out this form as thoroughly as possible and return to: TIPCOA,  3912 Monitor Mill Dr., Lafayette,

IN 47905.   Please submit a separate form for each person to be researched. A family

group sheet would really help to.  

 

Your Name: _____________________________ Address: ______________________________

City: __________________________________ State: ________ ZIP: __________________

Phone: (______)_________________________ E-Mail: _______________________________

 

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Ancestor's Name: ________________________________________________________________

Date of Birth: ________________________ Place of Birth: _________________________

Date of Death: ________________________ Place of Death: _________________________

Father: _______________________________ Mother: _________________________________

Spouse: _________________________________________________________________________

Marriage Info: __________________________________________________________________

Names of Children: ______________________________________________________________

_________________________________________________________________________________

What you would like us to research?: ____________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Places and records you have already researched: _________________________________

_________________________________________________________________________________

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