GENEALOGICAL INFORMATION FORM
Please, print, complete and return by post to:
ASSOCIATION DES FAMILLES KIROUAC INC.
31, Laurentienne, St-Étienne-de-Lauzon
(Québec) Canada - G6J 1H8
My name & surnames at birth: ______________________________________________________
My birth: D/M/Y: _____/_____/_____ Place: ___________________________________________
If married, name & surnames of spouse: _____________________________________________
His (her) birth: D/M/Y: ____/_____/_____ Place:
_______________________________________
Our marriage: D/M/Y: _____/_____/_____ Place:
______________________________________
Spouse - Father’s name & surnames: _____________________________________
K/ascd. ( )
Spouse – Mother’s name & surnames: _____________________________________ K/ascd. ( )
My father’s name & surnames: ____________________________________________K/ascd. ( )
His birth: D/M/Y:_____/_____/_____ Place: ____________________________________________
His death: D/M/Y:_____/_____/_____
Place:___________________________________________
My mother’s name & surnames at birth: __________________________________
K/ascd. ( )
Her birth: D/M/Y: _____/_____/_____ Place:
___________________________________________
Her death: D/M/Y:_____/_____/_____ Place:
___________________________________________
Their marriage: D/M/Y: _____/_____/_____ Place:
_____________________________________
K/rouac side grandparents name and surnames. Please
check if K/ ascendance
Grandfather: _____________________________________________________________ K/ascd. ( )
Grandmother (at birth): ___________________________________________________ K/ascd. ( )
Their marriage: D/M/Y: _____/_____/_____ Place: _____________________________________
If needed, please attach list or copies of this form for descendants.
I hereby authorize the Association des familles Kirouac inc. to keep and use my personal data strictly for it’s own use and for genealogical purposes and/or family history.
Signature _______________________________________ Date D/M/Y :_____/_____/_____