Application for Genealogical Research 1. Requestor´s Name, Adress and E-mail: .............................................................................................................................................................. ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… 2. The Ancestor a) Name……………………………………………………………………………………………………………. b) Date of Birth……………………………………………………………………………………………………. c) Place of Birth…………………………………………………………………………………………………… d) Parish, District Capital or Nearest City……………………………………………………………………… e) Father´s Given Name and Surname………………………………………………………………………... f) Mother ´s Given Name, Surname and Maiden Name…………………………………………………….. g) Religion…………………………………………………………………………………………………………. h) Other Relevant Information…………………………………………………………………………………... Relatives of the Ancestor (optional) Name and Relationship Date of Birth/Marriage Place of Birth/Marriage ………………………………………………………………………………………………………………………... ………………………………………………………………………………………………………………………... 3. Scope of Research a) Pedigree in Direct Male Line b) Ancestry Chart (All Ancestral Lines, Male and Female) Special requests: I request: Birth Records Marriage Records Death Records 4. If you posses any family documents related to the matter, enclose their copies, please. Price List Research of archival documents / charge per hour.…………………………………………….CZK 300,Packing charges - shipments in parcels................................................................................CZK 20,Postal charges shall be charged according to a valid price list of postal service providers. Note: We are to notify you of charging the research cost if there are negative results of the research as well. My limit on research costs is:……………………………..CZK. Date: Signature: Send your application to the following address, please: Státní oblastní archiv v Praze, Archivní 4/2257, 149 00 Praha 4 FAX +420 974 847 357, e-mail: e-podatelna@soapraha.cz Služební záznamy: Provedena 1. fáze řídící kontroly: Schváleno - neschváleno