Request #____________ Genealogical Research Request Form – Part 1 Your Name:___________________________________________________________________________ Mailing Address:_______________________________________________________________________ City______________________________________ State:___________ Zip Code:___________________ Phone:______________________________ E-mail:_________________________________________ Research fees
Sustaining or higher level of membership may request 1 complimentary hour per year and $25 per hour for subsequent hours of research. Complimentary hour used (date) _______________ *Please note:
Method of Payment
Researchers: The WCHS will invoice you for additional hours of research only if you authorize us to do so. Please check the box and indicate your budget.
Please complete as much of the relevant information on the form as possible. Use one form per individual/surname or topic to be researched. The fee is structured on a per request basis, not a cumulative total of research for the year. Each request is assigned an identification number. Your Name:___________________________________________________________________________ Name to be researched:__________________________________________________________________ Town or Township where they lived/died:___________________________________________________ Approximate span of years that they lived in the county:________________________________________ Names of children & relevant dates:________________________________________________________ _____________________________________________________________________________________ Religious affiliation:______________________________________________________________ Identify resources consulted thus far:_______________________________________________________ _____________________________________________________________________________________ What information do you hope to discover? You may attach additional sheets if necessary, but please be concise. Office use: Date processed ______________ Hours requested _____________ Budget ______________ Date Completed _____________
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