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 send your check for $30.00 made out to

Harrisburg Area YMCA

 

Mail to:

 

Mary E. Barber

220 Eutaw Avenue

New Cumberland,  PA  17070-2025