česká republika - státní oblastní archiv v praze

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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: [email protected]
Služební záznamy:
Provedena 1. fáze řídící kontroly: Schváleno - neschváleno
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