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, P.O. Box 2464, West Lafayette, IN 47996.
Please submit a separate form for each person to be researched. Please print:
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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For office use only.:
Received __________________
Assigned _________________ Completed __________________
Mailed ___________________
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