Application for Genealogical Services

Office of the Village Clerk
243 Main Street, Johnson City, New York 13790 - (607) 798-7861

APPLICATION FOR GENEALOGICAL SERVICES

To insure a complete search, provide as much information as possible. Please complete for type of record requested; Birth, Death or Marriage.
Birth

Name at Birth: _______________________________________________________

Date of Birth: Place of Birth: (Hospital or residence)_

Father's Name: ________

Mother's Maiden Name: **

Birth

Name at Birth: _

Date of Birth: Place of Birth: (Hospital or residence)_

Father's Name: ____________

Mother's Maiden Name: **

Death

Name at Death:

Date of Death: Age at Death: _

Names of Parents: ________________

Name of Spouse: _

Death

Name at Death: ____________________

Date of Death: Age at Death: _

Names of Parents: ________________

Name of Spouse: _

Marriage

Name of Bride: _

Name of Groom: __________________

Date of Marriage: _ Place of Marriage/License: _

Marriage

Name of Bride: _

Name of Groom:

Date of Marriage: _ Place of Marriage/License: _

Applicant Information

For what purpose is this information required? ___________

What is your relationship to person whose record is requested?

In what capacity are you acting? _

If requesting birth and marriage records: "To the best of my knowledge, the person(s) named in the application are deceased."
Signature of applicant: _ Date:
Print Name:
Address: ____________________________________________________________

Return to Genealogical Services Page