FORM FOR DATA SEARCH FROM THE FOUR FORMER PROVINCES

Form for data search from the four former provinces
of Eastern Poland
(Please print, using capital letters)

1. Name and surname (the exact name of the person or family) _____________________________________________
Change of name or different spelling
____________________________________________________________
2. Confession: (Pleas underline proper)

Evangelic (Protestant)

Judaic

Greek Catholic

Orthodox

Roman Catholic
3. Year, month, day of:
– Birth/baptism _____________________________________________________
– Marriage ________________________________________________________
– Death/burial ______________________________________________________
4. The name of a place (the name of a village or a town, parish or community, district and province) to which this person or family was connected:
Former province (Polish: województwo): (Please underline proper)

lwowskie

tarnopolskie

stanisławowskie

wołyńskie

District (Polish powiat) _________________________________________________
Parish (Polish parafia) or _______________________________________________
Community (Polish gmina) ______________________________________________
Name of the place _____________________________________________________
5. Your own name and address.
Title_____________ First Name ______________________ Surname ___________________
Address _____________________________________________________________________
Post Code ______________________________ City _________________________________
Country ________________________