Data Sheet

Family Data Sheet

Prepared by__________________________________________________  Date_____________
Address_____________________________________________________ Phone(___)________
City_________________________________________________ST________ZIP____________

Husband's Name________________________________________________________________
Address ______________________________________________________________________
______________________________________________________________________________
Born _______________ Where ___________________________________________________
Married _____________ Where ___________________________________________________
Died__________Where_____________________Buried Where__________________________ 
Father's Name_________________________Mother's name_____________________________

Wife's Name___________________________________________________________________
Address ______________________________________________________________________
_____________________________________________________________________________
Born __________ Where ________________________________________________________
Died ___________Where____________________ Buried Where _________________________
Father's Name _________________________Mother's Name ____________________________

Child's Name_____________________________________________________________Sex___
Address
_______________________________________________________________________
______________________________________________________________________________
Born __________Where _________________________________________________________
Married ________Who/Where ____________________________________________________
Died ___________Where ____________________ Buried Where_________________________

Child's Name_____________________________________________________________Sex___
Address
_______________________________________________________________________
______________________________________________________________________________
Born __________Where _________________________________________________________
Married ________Who/Where ____________________________________________________
Died ___________Where ____________________ Buried Where_________________________

Child's Name_____________________________________________________________Sex___
Address
_______________________________________________________________________
______________________________________________________________________________
Born __________Where _________________________________________________________
Married ________Who/Where ____________________________________________________
Died ___________Where ____________________ Buried Where_________________________

Child's Name_____________________________________________________________Sex___
Address
_______________________________________________________________________
______________________________________________________________________________
Born __________Where _________________________________________________________
Married ________Who/Where ____________________________________________________
Died ___________Where ____________________ Buried Where_________________________

Child's Name_____________________________________________________________Sex___
Address
_______________________________________________________________________
______________________________________________________________________________
Born __________Where _________________________________________________________
Married ________Who/Where ____________________________________________________
Died ___________Where ____________________ Buried Where_________________________


PLEASE COMPLETE & RETURN TO- Nancy Clemmer, 909 N Maize Rd. #307, Wichita,
KS 67212 or email at nanck@clemmer.org