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