GODFREY MEMORIAL LIBRARY

ONE SOURCE LOOKUP REQUEST FORM

If you would like us to do a lookup for you, fill out and submit this form. The cost is $ to request a copy from one source. We will make a digital scan and email it to you. Or, if you prefer, you can print out this form and mail it along with your check to The Godfrey Library, 134 Newfield Street, Middletown, CT 06457.

1. Citation or reference you would like us to look up

2. Provide any facts you know about this individual

Given Name [First Middle]
SURNAME [and any variant spellings]
Date and Place of Birth
Date and Place of Death
Name of Spouse [First Middle SURNAME]
Date and Place of Marriage
Names of Individual's Children
Names of Individual's Parents

3. Additional information that may help us fulfill your request

4. Tell us about yourself

Your Last Name
Your First Name
Address
City
State
Zip Code
Phone	()
Email

5. Donation

I would like to make a donation to the Godfrey Memorial Library in the amount of $
Godfrey Memorial Library is a 501(c)(3) organization. The amount of your donation is tax deductible. Thank you for your support.

6. Total

Total Amount (including donation) $

7. Submit the form and pay with paypal

Some users have experienced problems making paypal payments. If you experience any difficulty, try using a different browser or call the library for assistance (860) 346-4375.

134 Newfield Street (Route 3), Middletown, CT 06457
(860) 346-4375 Email refdesk@godfrey.org
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