Family History Questionnaire

Husband’s full name
Date of Birth / City and State of Birth
Date of Marriage / City and State of Marriage
Date of Death / City and State of Death
Date of Burial / City and Cemetery of Burial
Son of and
Names of other wives if any
Husband’s Occupation / Church affiliation if any
Wife’s full Maiden Name
Date of Birth / City and State of Birth
Date of Death / City and State of Death
Date of Burial / City and Cemetery of Burial
Daughter of and
Names of other husbands if any
Wife’s Occupation / Church affiliation if any
Please place Biographical material such as education, hobbies, interests, achievements, and military service on the back of this page
First Child /

Second Child

/ Third Child / Fourth Child / Fifth Child
First name / First name / First name / First name / First name
Middle name / Middle name / Middle name / Middle name / Middle name
Date of birth / Date of birth / Date of birth / Date of birth / Date of birth
Date of death / Date of death / Date of death / Date of death / Date of death
Spouse maiden name / Spouse maiden name / Spouse maiden name / Spouse maiden name / Spouse maiden name
Spouse date of birth / Spouse date of birth / Spouse date of birth / Spouse date of birth / Spouse date of birth
Marriage date / Marriage date / Marriage date / Marriage date / Marriage date
Spouse date of death / Spouse date of death / Spouse date of death / Spouse date of death / Spouse date of death
Children’s names / Children’s names / Children’s names / Children’s names / Children’s names
1) / 1) / 1) / 1) / 1)
2) / 2) / 2) / 2) / 2)
3) / 3) / 3) / 3) / 3)
4) / 4) / 4) / 4) / 4)
5) / 5) / 5) / 5) / 5)
6) / 6) / 6) / 6) / 6)
8/11/2007