Family or Individual Group Chart

Family or Individual Group Sheet

Date Submitted: __________________

Submitter’s Name	Street Address or P.O. Box	City	State	Zip Code

Male	Female
Name:_________________________________________	Name: _______________________________________
Birthdate: _______________ Source: _______________	Birthdate: ________________ Source: ______________
Where born: ____________________________________________	Where born: ____________________________________________
When married: ___________ Source: _______________	When married: ___________ Source: _______________
Where: _____________________________________________	Where: ____________________________________________
Death date: _______________ Source: ______________	Death date: ______________ Source: ______________
Where: _____________________________________________	Where: ____________________________________________
Where buried: _____________________________________________	Where buried: ____________________________________________
Occupation: _____________________________________________	Occupation: ____________________________________________
Residence: _____________________________________________	Residence: ____________________________________________
Marital status: single [] married [] partner []	Marital status: single [] married [] partner []

If applicable, please check: divorced [] annulled []	If applicable, please check: divorced [] annulled []
When:______________ Source:___________________	When:______________ Source:____________________
Name of former spouse: __________________________	Name of former spouse: ___________________________

Any additional information:

_______________________________________________________________________________________________________

**Children**
1. Name: _____________________________________________		Sex: Male [] Female[]	Status: Natural [] Adopted []
Birthdate: _____________________	Source: ____________________	Where: ___________________________________________________
Deathdate: ____________________	Source: _____________________	Where: ______________________________	Where buried: _________________
Other Note:___________________________________________________________________________________________
2. Name: _____________________________________________		Sex: Male [] Female[]	Status: Natural [] Adopted []
Birthdate: _____________________	Source: ____________________	Where: ___________________________________________________
Deathdate: ____________________	Source: _____________________	Where: ______________________________	Where buried: _________________
Other Note:___________________________________________________________________________________________
3. Name: _____________________________________________		Sex: Male [] Female[]	Status: Natural [] Adopted []
Birthdate: _____________________	Source: ____________________	Where: ___________________________________________________
Deathdate: ____________________	Source: _____________________	Where: ______________________________	Where buried: _________________
Other Note:___________________________________________________________________________________________
4. Name: _____________________________________________		Sex: Male [] Female[]	Status: Natural [] Adopted []
Birthdate: _____________________	Source: ____________________	Where: ___________________________________________________
Deathdate: ____________________	Source: _____________________	Where: ______________________________	Where buried: _________________
Other Note:___________________________________________________________________________________________

**Children (cont)**
5. Name: _____________________________________________		Sex: Male [] Female[]	Status: Natural [] Adopted []
Birthdate: _____________________	Source: ____________________	Where: ___________________________________________________
Deathdate: ____________________	Source: _____________________	Where: ______________________________	Where buried: _________________
Other Note:___________________________________________________________________________________________
6. Name: _____________________________________________		Sex: Male [] Female[]	Status: Natural [] Adopted []
Birthdate: _____________________	Source: ____________________	Where: ___________________________________________________
Deathdate: ____________________	Source: _____________________	Where: ______________________________	Where buried: _________________
Other Note:___________________________________________________________________________________________
7. Name: _____________________________________________		Sex: Male [] Female[]	Status: Natural [] Adopted []
Birthdate: _____________________	Source: ____________________	Where: ___________________________________________________
Deathdate: ____________________	Source: _____________________	Where: ______________________________	Where buried: _________________
Other Note:___________________________________________________________________________________________
8. Name: _____________________________________________		Sex: Male [] Female[]	Status: Natural [] Adopted []
Birthdate: _____________________	Source: ____________________	Where: ___________________________________________________
Deathdate: ____________________	Source: _____________________	Where: ______________________________	Where buried: _________________
Other Note:___________________________________________________________________________________________

[Please attach another sheet for additional children]

Any additional information:

_______________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________

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