Family Questionnaire

Hello, I am researching the various family lines of my family to create a broad family history. I would very much appreciate as much information as you can provide to me about your family. Of course, returning this form is not mandatory, but it would certainly help me in my research, and I would appreciate it very much. The easiest way is to simply fill in as much information as you can, save it on your computer and e-mail it back to me. It has been designed to allow you to simply tab between topics. Please return this form with as much of the information as you know to chjorenby@gmail.com or you could mail it to: Chuck Jorenby and Sue Heaton 14688 Rosewood Rd. NE Prior Lake, MN 55372 Husband/Father Information Husband's Name: E-mail address: Phone: Birth Date: Place: Christening Date: Place: Occupation: Death Date: Place: Burial Date: Place: Any additional information (i.e.; military history, memberships, or accomplishments) to add: Husband's Father's Name: E-mail address: Phone: Birth Date: Place: Christening Date: Place: Occupation: Death Date: Place: Burial Date: Place: Any additional information (i.e.; military history, memberships, or accomplishments) to add: Husband's Mother's Name: E-mail address: Phone: Birth Date: Place: Christening Date: Place: Occupation: Death Date: Place:

Burial Date: Place: Any additional information (i.e.; military history, memberships, or accomplishments) to add Husband's Paternal Grandfather's Name: E-mail address: Phone: Birth Date: Place: Christening Date: Place: Occupation: Death Date: Place: Burial Date: Place: Any additional information (i.e.; military history, memberships, or accomplishments) to add: Husband's Paternal Grandmother's Name: Husband's Maternal Grandfather's Name: E-mail address: Phone: Birth Date: Place: Christening Date: Place: Occupation: Death Date: Place: Burial Date: Place: Any additional information (i.e.; military history, memberships, or accomplishments) to add: Husband's Maternal Grandmother's Name: E-mail address: Phone: Birth Date: Place: Christening Date: Place: Occupation: Death Date: Place: Burial Date: Place: Any additional information (i.e.; military history, memberships, or accomplishments) to add: Wife/Mother Information Wife's Name (maiden name): E-mail address: Phone: Birth Date: Place: Christening Date: Place: Occupation: Death Date: Place: Burial Date: Place: Any additional information (i.e.; military history, memberships, or accomplishments) to add:

Wife's Father's Name: E-mail address: Phone: Birth Date: Place: Christening Date: Place: Occupation: Death Date: Place: Burial Date: Place: Any additional information (i.e.; military history, memberships, or accomplishments) to add: Wife's Mother's Name: Wife's Paternal Grandfather's Name: E-mail address: Phone: Birth Date: Place: Christening Date: Place: Occupation: Death Date: Place: Burial Date: Place: Any additional information (i.e.; military history, memberships, or accomplishments) to add: Wife's Paternal Grandmother's Name: E-mail address: Phone: Birth Date: Place: Christening Date: Place: Occupation: Death Date: Place: Burial Date: Place: Any additional information (i.e.; military history, memberships, or accomplishments) to add: Wife's Maternal Grandfather's Name: E-mail address: Phone: Birth Date: Place: Christening Date: Place: Occupation: Death Date: Place: Burial Date: Place: Any additional information (i.e.; military history, memberships, or accomplishments) to add: Wife's Maternal Grandmother's Name: E-mail address: Phone: Birth Date: Place: Christening Date: Place:

Occupation: Death Date: Place: Burial Date: Place: Any additional information (i.e.; military history, memberships, or accomplishments) to add: Marriage Information Marriage Date: Place: Children Information Child: M/F : Name:: Birth Date: Place: Christening Date: Place: Death Date: Place: Burial Date: Place: Spouse (maiden name): Child: M/F : Name:: Birth Date: Place: Christening Date: Place: Death Date: Place: Burial Date: Place: Spouse (maiden name): Child: M/F : Name:: Birth Date: Place: Christening Date: Place: Death Date: Place: Burial Date: Place: Spouse (maiden name): Child: M/F : Name:: Birth Date: Place: Christening Date: Place: Death Date: Place: Burial Date: Place: Spouse (maiden name): Other Information to share or add: There are a couple purposes for this form: First, to see if our families come from a common ancestor and second, to simply locate the various family members around the country. If you have any more information than that requested above, I would dearly love to have it. Or, if you have any pictures, certificates, old documents, etc. from the past, I would very much like to get a copy of them. Not only would they help my

research but will also make the forthcoming history more interesting. I will gladly send a copy to anyone who responds. Thank you very much for your time.