APPLICATION FOR SEARCH OF VITAL RECORDS
FILED IN THE TOWN OF MOREAU
(FOR GENEALOGICAL PURPOSES) (PROOF OF I.D. MUST BE SUBMITTED WITH APPLICATION)



BIRTH RECORD (MUST BE ON FILE FOR 75 YEARS OR MORE)

NAME AT BIRTH: __________________________________________

DATE OF BIRTH: __________________________________________

PLACE OF BIRTH: __________________________________________

FATHER'S NAME: __________________________________________

MOTHER'S MAIDEN NAME: __________________________________________

YOUR RELATIONSHIP TO THE PERSON NAMED IN THE BIRTH RECORD

ABOVE: _________________________________

PURPOSE FOR WHICH INFORMATION IS NEEDED:______________________________

TO THE BEST OF MY KNOWLEDGE, THE PERSON NAMED IN THIS

APPLICATION IS DECEASED: _________________________________

Signature of Applicant



DEATH RECORD (MUST BE ON FILE FOR 50 YEARS OR MORE)

NAME AT DEATH: __________________________________________

DATE OF DEATH: _______________ AGE AT DEATH: __________

PLACE OF DEATH: __________________________________________

FATHER'S NAME: __________________________________________

MOTHER'S MAIDEN NAME: __________________________________________

NAME OF SPOUSE: __________________________________________

YOUR RELATIONSHIP TO THE PERSON NAMED IN THE DEATH RECORD

ABOVE: _________________________________

PURPOSE FOR WHICH INFORMATION IS NEEDED:______________________________



_________________________________

Signature of Applicant



MARRIAGE RECORD (MUST BE ON FILE FOR 50 YEARS OR MORE)

NAME OF BRIDE: _________________________________________

NAME OF GROOM: _________________________________________

DATE OF MARRIAGE: _________________________________________

PLACE OF LICENSE: _________________________________________

PLACE OF MARRIAGE: _________________________________________

YOUR RELATIONSHIP TO THE PERSONS NAMED IN THE MARRIAGE

RECORD ABOVE: ________________________

PURPOSE FOR WHICH INFORMATION IS NEEDED:______________________________

TO THE BEST OF MY KNOWLEDGE, THE PERSONS NAMED IN THIS

APPLICATION ARE DECEASED: _________________________________

Signature of Applicant





Name of Applicant (PRINT): __________________________________________

Street Address: __________________________________________

City, State & Zip Code: __________________________________________

Area Code & Tel. No.: ______________

Signature: ____________________________________ Date: ____________________