Example #1 For you or others

I__Fernand-Pierre Cyrenne________dauther/son of ___Henri Cyrenne____________ and grand dauther/grand son of __Armand Cyrenne________ authorize that the genealogical data that I am submitting be added to the Cyrenne and Syrenne family tree on the Web. (The names of your father and grand-father are needed to make connection between your data and that of the local computer).

I am submitting the following data: (i)

Personel genealogical data

Family name:__Cyrenne___________________________
First name:___Fernand-Pierre____________________
Born on: ____16/02/1943_________________________
Born at:_____Trois-Rivières_____________________
Maried on: ____11/04/1964_______________________
Maried at:____Québec____________________________
Deceased on: __________________________________________
Deceased at: __________________________________________

Spouse's data (signature requised)

Family name:____Michaud_________________________
First name:___Solange___________________________
Born on: ___16/12/1945__________________________
Born at: ___St-Cléophas_________________________
Deceased on: _________________________________________
Deceased at: __________________________________________

Form for a deceased relative

If the form is for deceased relatives, do not forget to enter their deceased dates. Follow the date format (ii) for all dates entered. Enter your family relationship with the above relative (dauther, son, oncle, father etc...) ___________________

Please do not forget your signature,

your E-mail addresse: _xxx@yyy.com_____________and

your postal addresse on the back of the form

Signed at __F.P Cyrenne on01/01/1997 Your signature _________________Spouse / Witness_S. Michaud_____

Mail to:
Cyrenne and Syrenne Genelogical Centre
37 Buckingham rd
Val des Monts (Perkins) Qc
J8N 7L3

(i) Except for first and family names, all other fields are optionnelles
(ii) Date format: DD/MM/YYYY or /MM/YYYY or /YYYY

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