RESEARCH REQUEST FORM GUIDELINES FOR RESEARCH: Our members volunteer their time and effort to assist requests for research through the West Kentucky African American Museum and Research Center. Volunteers are not genealogists and provide this service without compensation. Because we are volunteers, research can take six (6) to eight (8) weeks. All proceeds are used to further the purposes of the Society. (Please print) Each search is for one family name only. It is best if you can give us the following information:

Ancestor Name to Research:________________________________________________________________________

 Date of Birth: ________________

Place of Birth:______________________________________

Married to: _________________________________________________

Date of Marriage: _____________________

 Place of Marriage: ______________________________________________

 Date of Death: ________________________

Place of Death: ________________________________________________

Parents: (Father) ___________________________________________________________________________________ (Mother) __________________________________________________________________________________
Children: What specific questions do you want answered? Any additional information you think will help us help you? Services Requested Maximum amount of research hours you are requesting? _________ Hours X $25 per hour = $__________ Deed or Will copies requested: _________ copies X $10 each = $__________ Total amount of check enclosed: $__________ Please make check payable to: Historic Russellville _________________________________________________________________ Address _______________________________________________________________________________ City ______________________________________________ State __________ Zip _________________ Daytime Phone No. ___________________________ Email ____________________________________ Signed _______________________________________________ Date­­­­­­­­­­­­____________________________