Genealogy Questionnaire

Isle Madame Historical Society
708 Veterans Memorial Dr.
P.O. Box 223, Arichat, N.S.
B0E 1A0

(phone # (902) 226-9364
or (902) 226-2880;
 Email: islemadamehistoricalsociety@gmail.com>
www.imhs.ca

( Please include any research that was done prior to contacting us )

Your name: ____________________________________________

Address: ______________________________________________

E-mail address: ______________________

Date: ______________________________

Name to search for: _____________________________________

Relationship to the above: _________________________________

Fill in as much as possible about the person sought.

Date of Birth: __________________ Place: ____________________

Date of Death: _________________ Place: ____________________

Father and Mother: ________________________________________

Brothers and Sisters: ______________________________________

Aunts and Uncles: _________________________________________

Spouce: ________________________________________________

Children: ________________________________________________

Religion: _____________________ Residence: _________________

Occupation: ______________________________________________

Other information you can add such as stories, nicknames, etc: _______

________________________________________________________

(Please include any research that was done prior to contacting us)