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Questionnaire
The research department requires certain details about a
known Mayo ancestor before they can begin a search of the
records available to them. Please answer as many questions
as possible and add or enclose any further information you
have which is not covered by this questionnaire.
Your Ancestor's
Details
All following questions relate specifically to the person
named at A. The ancestor named at A should have a birth date
prior to 1901.
A Your ancestor's full
name
_____________________________________________________________________
B Date and place of
birth
_____________________________________________________________________
_____________________________________________________________________
C Mother (name &
pre-marriage surname)
_____________________________________________________________________
Father (name)
_____________________________________________________________________
Brothers and Sisters
(names)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
D Marriage(s) (any
available information & dates)
_____________________________________________________________________
_____________________________________________________________________
E Death details (date
& place of burial)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
F Emigration details (if
any)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
G
Occupation
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
H Religious
denomination
_____________________________________________________________________
I Any other
details
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Declaration
- I have read Information Sheet
1 and Information Sheet
2
- I am a direct descendant of the person described in
the ancestral details on this form.
- Any information I receive as a result of this
undertaking will not be submitted in legal
proceedings.
I have read and understand the above.
Signed: ______________________________ Date:
__________________
You may wish to make a copy of this
application for your records.
Fees
The assessment fee is Euro75 (approx US$95) (or, the
equal amount in your own currency). This fee is based on the
time and expense involved in carrying out a thorough
assessment. Please forward the fee with this form.
Please make cheques payable to: Mayo Family History
Research Centre
You can also pay by Master Card or
Visa. Please enter Credit Card details below.
Account No _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Card Holder's name
______________________________________________
Expiry Date ______________________
Type of Card _____________________________
Card Holder's address
_______________________________________
________________________________________________________________
Signed by Card Holder
_______________________________________________
Market
Research
As part of our on-going market research programme, we
would be grateful if you completed the following: (This
information is purely for statistical purposes.)
Q1) How did you hear about the Mayo Family History
Centres?
_____________________________________________________________________
_____________________________________________________________________
Q2) Please indicate with a whether you are Male or Female
____________
Please indicate with your age group: 18-24, 25-34, 35-44,
45-54, 55-64, 65+ _________
Q3) Your occupation:
______________________________________________________________
Your co-operation is much appreciated.
For Office Use
Only
Customer No.: ____________________ Date:
____________________
(c) Copyright Mayo Family History Marketing Company
Ltd.
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