Questionnaire

Information received through this questionnaire, will be treated as confidential information. It will only be used for my personal geneology research, and will not be released to any other person or company.             J.H. Doldersum

(please note: the item marked with "#" is a required field).
Name
E-mail  #
Bapt.name
First name
Birthday
Gender Male Female
Matrimonial state

 

Married Living together   Since:

Divorced   Since:

Name Father
Bapt. name
First name
Birthdate    Deceased:
Cemetery
Name Mother
Bapt. name
First name
Birthdate    Deceased:
Cemetery
Name partner**
Marr.location

 

 * * =  Information about "Name Partner" can be added in the next card.

Data partner:

Name
Bapt.name
First name
Birthdate
Gender Male Female
Occupation
Deceased
Cemetery

Children from this relationship:

Name
Bapt.name
Firstname
Birthdate
Gender MaleFemale Adopted: Yes ?

 

Name
Bapt.name
Firstname
Birthdate
Gender MaleFemale Adopted: Yes ?

 

Name
Bapt.name
Firstname
Birthdate
Gender MaleFemale Adopted: Yes ?

 

Name
Bapt.name
Firstname
Birthdate
Gender MaleFemale Adopted: Yes ?

 

Name
Bapt.name
Firstname
Birthdate
Gender MaleFemale Adopted: Yes ?

If one or more children originated from another relationship, this could be mentioned in the text-block at the bottom of this page.

If there are more the 5 children, this also could be mentioned in the text-block.

If you have any information to add, or if you have a question, you could use the text-block. E-mail is also possible.

If there are children on this form, who formed a family of their own, they could fill in a "questionnaire" of their own.

If there is anything you would like to ask, or if you could contribute something to this research, please don't hesitate to contact me.

Thank you very much,   Joop Doldersum.                      

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Copyright 2000   J.H. Doldersum  Alle rechten voorbehouden / All rights reserved.
Herzien: febr.2005