Family Surname Request Form

Family Surname Research Request Form
Please provide as much information as you can. The more you tell us, the better we are able to locate your ancestor, not someone else with the same name and similar dates.

Print this page, complete the form, and mail it, with a check for $65 (per surname) payable to the S.C.H.S. (additional copies over the first 8 will be billed), to

        Susquehanna County Historical Society
        2 Monument Square
        Montrose, PA 18801

Person you want researched:

Town, township of residence:

Time of residence:

Birth date and place:

Marriages, dates and places:

Death date and place:

Resources you have already checked:

Census (please specify years and places):

County/other local histories:

Family/bible/other records

Additional information: Please provide as much additional information as you can either in the following space or on other sheets you can send us with this form -- such as names and dates for all spouses, children, siblings, parents, other; church membership; place of burial; other places of residence; etc.:

Your Name:

Address:

Phone Number:

E-Mail:

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