Please print in "Landscape" mode, fill in pages 2 & 3 and air-mail to Mr C. T. Chiba at the address below.

Genealogical survey.

The information herewith supplied is strictly confidential between you and the database and only with your written permission will it be made public excepting the following items: your , your spouse's and children's' names, years of births and deaths occupation, country of residence.

Contacts for correspondence in Magyar or English:

Mr. Charles Chiba

51 Clarence St

Elsternwick, 3185

Australia

Telephone and fax +61 (3) 9528 2002. E-mail: chibac@melbpc.org.au OR csiba@bigfoot.com Internet: http://www.geocities/Heartland/Plains/3807

If you cannot provide an exact answer to a question because the data may have been lost, a careful estimate followed by a question mark will do. Eg. 1950(?) or

György (?) or Csorna(?).

Underage children living with you. (Grown up children need to fill in a form in their own right.)

Would you be interested in getting a computer disk of the Family Tree? (Written in Microsoft Excel latest version)Y/N. Perhaps you would like to provide

information concerning your spouse's parents and grandparents; please do so, it will fit into the database. If you think that, apart from the above, you have

data that you consider important enough to be entered in the database they will be welcome; for example: war service, military or civil decorations, prisoner of

war experience, prison, deportation, forced labour, confiscation of assets, meritorious civil service or public offices held, books published, major achievements

in schools, trades, professions, academia, political life, workplace, the arts, sciences and sports and anything else in your life that you normally like

to talk about, or even the customary "skeleton in the cupboard"! Xerox copies of birth, marriage and death certificates are also welcome.

Photos and paintings will be taken into the database depending on their computer memory requirements

The farther back on your family branch can you go, the more precious is your contribution. For any further comments please write on and

attach a separate sheet

* * * * * * * * * * * *You * * * Your * * * Your * * *Your * * * Your * * *Your * * * Your paternal* * * Your paternal
yourself spousefather motherpaternal paternalgreat great
grandfathergrandmother grandfathergrandmother
Family name
At birth:
Adopted family name:
Given names:
At birth:
Adopted given names:
Born:
Town
Country
Date or year
Natural or Adopted
Religion baptised
Death:
Town* * *
Country* * *
Date or year * * *
Cause of death if known* * *
Marriage:
Town
Country
Date or year
Remarks concerning
the wedding:
Occupation:
Postal address:
Number and street
Town
State
Postcode (Zip)
Country
Telephone
Fax
eMail
Internet address
* * * * * * * * * * * * * * * Child 1 * * * * Child 2 * * * * Child 3 * * * *Child 4 * * * *Child 5 * * * *Child 6 * * * *
Family name
At birth:
Adopted family name:
Given names
At birth:
Adopted given names:
Born:
Town
Country
Date or year
Father's name
Mother's name
Natural or adopted
Religion baptised
Signature:                               Date:                          



                                                                                                                           

(This form was last updated: 11 Jan. 1998)