Genealogical Information for Nickerson Descendents

Print out this form and fill it in, then send it with your membership application.
Your Name_______________________________________________________________

Address_________________________________________________________________

Born on ___________________________________ at___________________________

Your Father_____________________________________________________________

	Born on___________________________ at___________________________

	Died on___________________________ at___________________________

	Son of___________________________ and___________________________

Your Mother ____________________________________________________________

	Born on___________________________ at___________________________

	Died on___________________________ at___________________________

  Daughter of______________________ and___________________________

Marriage of Parents on____________________ at___________________________

Your Spouse_______________________________________________________

	Born on___________________________ at___________________________

	Died on___________________________ at___________________________

Spouse's Father____________________________________________________________

	Born on___________________________ at___________________________

	Died on___________________________ at___________________________

	Son of___________________________ and___________________________

Spouse's Mother____________________________________________________________

	Born on___________________________ at___________________________

	Died on___________________________ at___________________________

	Daughter of______________________ and___________________________

Your Marriage Date________________________ at___________________________

Your Children:

	Name____________________________________________________________

	Born on___________________________ at___________________________

	Married on________________________ at___________________________

	Spouse__________________________________________________________

	Born on___________________________ at___________________________

	Parents__________________________ and___________________________

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	Name____________________________________________________________

	Born on___________________________ at___________________________

	Married on________________________ at___________________________

	Spouse__________________________________________________________

	Born on___________________________ at___________________________

	Parents__________________________ and___________________________

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	Name____________________________________________________________

	Born on___________________________ at___________________________

	Married on________________________ at___________________________

	Spouse__________________________________________________________

	Born on___________________________ at___________________________

	Parents__________________________ and___________________________

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	Name____________________________________________________________

	Born on___________________________ at___________________________

	Married on________________________ at___________________________

	Spouse__________________________________________________________

	Born on___________________________ at___________________________

	Parents__________________________ and___________________________

Your Uncles, Aunts, Cousins, Brothers, Sisters and Grandparents

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©2002 Nickerson Family Association, Inc.