Family Tree Questionnaire

When filling out this questionnaire, please write the full name of each person.  EXAMPLE :  Jonathan Henry Smith.  Please print or type, and answer all questions to the best of your ability.  Please include city and country for questions which ask about births, deaths, burials, marriages, and divorces.

Section 1

Husband's name : 												
Date of birth :				  Birth Place :								
Date of death :				  Death Place :								
Date of  burial :			  Place of Burial :							
Date Christened :			  Place Christened :							
Other :																												

Wife's name (Maiden name) :											
Date of birth :				 Birth place :								
Date of death :				 Death place :								
Date of marriage :			 Marriage location :							
Date of divorce :			 Divorce location :							
Date of  burial :			 Place of Burial :							
Date Christened :			 Place Christened :							
Other :																												

Section 2

List names of all children oldest to youngest. If child was adopted list date of adoption, and from what adoption agency, orphanage, or hospital.

Name : 										 Sex: 			
Date of birth :				 Birth Place :								
Date of death :				 Death Place :								
Date of  burial :			 Place of Burial :							
Date Christened :			 Place Christened :							
Other :																												

Name : 										 Sex: 			
Date of birth :				 Birth Place :								
Date of death :				 Death Place :								
Date of  burial :			 Place of Burial :							
Date Christened :			 Place Christened :							
Other :																												

Name : 										 Sex: 			
Date of birth :				 Birth Place :								
Date of death :				 Death Place :								
Date of  burial :			 Place of Burial :							
Date Christened :			 Place Christened :							
Other :																												

Name : 										 Sex: 			
Date of birth :				 Birth Place :								
Date of death :				 Death Place :								
Date of  burial :			 Place of Burial :							
Date Christened :			 Place Christened :							
Other :																												

Name : 										 Sex: 			
Date of birth :				 Birth Place :								
Date of death :				 Death Place :								
Date of  burial :			 Place of Burial :							
Date Christened :			 Place Christened :							
Other :																												

Name : 										 Sex: 			
Date of birth :				 Birth Place :								
Date of death :				 Death Place :								
Date of  burial :			 Place of Burial :							
Date Christened :			 Place Christened :							
Other :																												

List additional children at the end of this form.

Section 3 - Only complete this section if a related to the Surname in question.

Husband
Name of Father : 												
Date of birth :				  Birth Place :								
Date of death :				  Death Place :								
Date of  burial :			  Place of Burial :							
Date Christened :			  Place Christened :							
Other :																												


 

Name of mother (Maiden name ):										
Date of birth :				 Birth place :								
Date of death :				 Death place :								
Date of marriage :			 Marriage location :							
Date of divorce :			 Divorce location :							
Date of  burial :			 Place of Burial :							
Date Christened :			 Place Christened :							
Other :																												
List  all of your brothers and sisters, and dates of birth (if known) for easier tie-ins :

1. 														
2. 														
3. 														
4. 														
5. 														
6. 														
Any additional siblings, please list at the end of this form.

Section 4 - Only complete this section if a related to the Surname in question.

Wife
Name of Father : 												
Date of birth :				  Birth Place :								
Date of death :				  Death Place :								
Date of  burial :			  Place of Burial :							
Date Christened :			  Place Christened :							
Other :																												

Name of mother (Maiden name ):										
Date of birth :				 Birth place :								
Date of death :				 Death place :								
Date of marriage :			 Marriage location :							
Date of divorce :			 Divorce location :							
Date of  burial :			 Place of Burial :							
Date Christened :			 Place Christened :							
Other :																												

List  all of your brothers and sisters, and dates of birth (if known) for easier tie-ins :
1. 														
2. 														
3. 														
4. 														
5. 														
6. 														
Any additional siblings, please list at the end of this form.

If you have any additional information about our family, such as military history, immigration dates, places and ship names; please mail it to me.  All information is welcomed.  Thank you for your time and cooperation with our family history.  Please return questionnaire to address below.


Randy Whitmore
1816 Mimosa Ave.
Charlotte, NC  28205-3024
E-mail  Rpwhitmore@AOL.com
Home (704) 332-5640
Fax (704) 370-0916

Your name:								Good time to 
Address:								contact you:				
	  								Phone Number:			
	  							
	  							

Additional information:
																																																																																																																																																																																																																		
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