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.  Ensure to include city and country for questions which ask about births, deaths, burials, marriages, and divorces.


Husband’s name :_________________________________________________________
Date of birth :_________________  Birth Place :_________________________________
Date of death :________________  Death Place :_________________________________
Place of burial :____________________________

Wife’s name (Maiden name) :_________________________________________________
Date of birth :_________________  birth place :__________________________________
Date of death :________________   death place :_________________________________
Place of burial :____________________________
Date of marriage :______________  Marriage location :____________________________
Date of divorce :_______________  Divorce location :_____________________________

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

1._______________________________________________________________________
2._______________________________________________________________________
3._______________________________________________________________________
4._______________________________________________________________________
5._______________________________________________________________________
6._______________________________________________________________________

List additional children on separate sheet of paper.



If you or your spouse is in the following line of family(ies), please answer the following questions.
Please indicate whose parent they are :____________________________________________

First family name
Second family name
Third family name
Fourth family name

Name of father :_____________________________________________________________
Date of birth :____________________  birth place :_________________________________
Date of death :___________________   death place :________________________________
Place of burial :____________________________
If this person immigrated here, list date of immigration, name of ship, and port of entry :______
_________________________________________________________________________
_________________________________________________________________________


Name of mother (Maiden name ):________________________________________________
Date of birth :____________________  birth place :_________________________________
Date of death :___________________   death place :________________________________
Place of burial :____________________________
If this person immigrated here, list date of immigration, name of ship, and port of entry :_____
__________________________________________________________________________
__________________________________________________________________________
Date of marriage :______________  Marriage location :_______________________________
Date of divorce :_______________  Divorce location :________________________________


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 on a separate sheet of paper.


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.


Your name
Address
City, Post Code

Phone number






Questionnaire written by John Hugh Glen