One Source Lookup Request

REQUEST FORM

"*" indicates required fields

If you would like us to do a lookup for you, fill out and submit this form. The cost is $30 to request a copy from one source. We will make a digital scan and email it to you. Or, if you prefer, you can print out this form and mail it along with your check to The Godfrey Library, 134 Newfield Street, Middletown, CT 06457.

Request a copy from one source

Citation or Reference

Citation or reference you would like us to look up*

Individual Information

Provide any facts you know about this individual

Given Name [First Middle]

SURNAME [and any variant spellings]

Date and Place of Birth

Date and Place of Death

Name of Spouse [First Middle SURNAME]

Date and Place of Marriage

Names of Individual's Children

Names of Individual's Parents

Additional Information

Provide any facts you know about this individual

Additional information that may help us fulfill your request

Your Information

Name*

First Name Last Name

Phone

Email*

Address*

Street Address City State ZIP Code

Donation

I would like to make a donation to the Godfrey Memorial Library in the amount of

Godfrey Memorial Library is a 501(c)(3) organization. The amount of your donation is tax deductible. Thank you for your support.

Total

Total Amount (including donation)