1.      I ____________________________________was born on ______________________________________

       at___________________________________________________________________________________
                                                 City                                             County                                                  State
2.      I am the child of _________________________________________________________________________

      born on ____________at__________________________________________________________________ 
                                                                                City                                       County                                          State

      died on ____________at__________________________________________________________________
                                                            City                                      County                                           State
      
and_______________________________ (his, her) (wife, husband)

     born on ____________at__________________________________________________________________
                                                            City                                       County                                           State
     
died on _____________at__________________________________________________________________
                                                            City                                       County                                            State
     
married on ___________at__________________________________________________________________
                                                            City                                       County                                            State
    
The said _________________________________________________________was the (son, daughter) of

3. ________________________________________________________________________________________

    born on ______________at__________________________________________________________________
                                                              City                                     County                                             State
    died on _____________at___________________________________________________________________
                                                              City                                     County                                             State
    
and_______________________________ (his, her) (wife, husband)

    born on _____________at___________________________________________________________________
                                                              City                                     County                                             State
    died on _____________at____________________________________________________________________
                                                              City                                     County                                             State
    
married on ____________at__________________________________________________________________
                                                              City                                     County                                             State
   
The said _________________________________________________________was the (son, daughter) of

4. _______________________________________________________________________________________

    born on ______________at________________________________________________________________
                                                               City                                      County                                            State
    
died on ______________at_________________________________________________________________
                                                               City                                      County                                            State
    
and_______________________________ (his, her) (wife, husband)

    born on _____________at_________________________________________________________________
                                                                City                                       County                                          State
    
died on _____________at_________________________________________________________________
                                                                City                                       County                                          State
    
married on ____________at________________________________________________________________
                                                                City                                       County                                          State
 
The said _________________________________________________________was the (son, daughter) of
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