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County Roscommon Heritage And Genealogy Company Ltd. Church
St., Strokestown, Co. Roscommon.
Tel: 071-9633380
Fax: 071-9633398
Email: info@roscommonroots.com
Web: www.roscommonroots.com
Application For Tracing Your County Roscommon Ancestral
Roots
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| TELEPHONE
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| EMAIL ADDRESS:
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| TYPE OF
SEARCH(PLEASE TICK): |
| Assessment - 75 euro |
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Individual Record - 30 euro |
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| Method of payment
- please tick |
| Cheque |
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| Cash |
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| Visa |
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| Amex |
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| Mastercard |
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| Laser |
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| Other |
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| Credit Card No: |
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| Exp Date: |
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| CV2 Number |
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| Signature: |
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| For Official
Use Only: |
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REF NO. |
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REC NO. |
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| Your
Ancestral Information |
| Ancestor's Place of Birth
in County Roscommon: |
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| Ancestor's Mother (including
her pre marriage surname): |
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| Ancestor's approximate year
of birth: |
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| Ancestor's religious denomination: |
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| Name of ancestor's husband
or wife: |
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| Names of any children born
in County Roscommon: |
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| When did your ancestor emigrate? |
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| Did your ancestor's parents
emigrate? |
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| Further information (if necessary
use a separate sheet): |
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| I have read this form and I am availing
of this service to obtain information solely about my own family lineage.
Any information I may receive as a result of this undertaking will
be used for private research only, and will not be submitted in legal
proceedings. |
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