RESEARCH REQUEST FORM
Please complete with as much information as known:
YOUR NAME _______________________ PHONE/EMAIL _________________
ADDRESS _____________________________________
STATE _________________________
ZIP ________________
Full name of the individual in whom you are interested: __________________________
Exact or approximate dates of birth _____________ death ____________________
Known parents/siblings ____________________________________________________
Spouse __________________________________ Marriage Date __________________
Place of residence _________________________________________________________
What records have you already searched? _____________________________________
__________________________________________________________________________
Please state briefly what information you are seeking:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Please make check for $30.00 payable to: HARRISBURG AREA YMCA
SEND TO: WEST SHORE GENEALOGY CLUB C/O WEST SHORE YMCA
410 FALLOWFIELD RD. CAMP HILL, PA. 17011