Genealogy Questionnaire
Isle Madame Historical Society
2543 Hwy 206, P.O. Box 223, Arichat, N.S. B0E 1A0
Ph. # (902) 226-0456 Email: <imhistoricalsociety@hotmail.com>
www. arichat.com/imhs

(Please mention any research made before and if possible, where it was done.)

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 mention any research made before and where it was done.)