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VJ XK COUNTY HISTORICAL SOCIETY	.Gk
v->' Post Office 3ox 13^0	'(1^1
Bay St. Louis, Mississippi 39^20	if c'
In order for us to process your request form must be completed and forwarded to us. Only four (I4) records will be searched at one time. Your letter will be crossed indexed by our society and names will be entered into a surname file of the society for future public research.
To maintain the cost and service our society asks a donation of ten dollars ($10.00) which is Tax deductible tot" he donor, society tax exempt corporation number 6li-06l33hO.
RECORDS RESEARCHED BY SOCIETY
DEEDS OF LAND, CEMETERY, NATURALIZATION, MILITARY, SOCIETY SURNAME INDEX,?
SOCIETY SUBJECT FILE, CENSUS, NAT?.TIALIZATIOK^SUBJECT OF YOTJR CHOICE.
XXEROX COPIES OF SOCIETY RECORDS ARE FIFTY CENTS (.500) PER COPY PAGE.
^ ?
MARRIAGE, DEATH, BIRTHS RECORDS MAY BE LOCATED, THE SOURCE WILL BE FORWARDED TO YOU AND CAN BE ORDERED DIRECT.
RESEARCH APPLICATION FORM
(l.'/^NAME OR SUBJECT QcTav?	_______________________________________
State name in full (if known)	\	0	JJ
RECORD REQUEST m*TH	-	fl/Vp ^ jlMS IW*>	I
Type	a-	?	</	Circa (10 year, date range) /7
|	I	?	-	? ? I ?}
(2p) |NAME OR SUBJECT OoTflyr \ 1 ffi/j/v/z/l}
State name, in full, if (known). - . V i ~j i	n
RECORD REQUEST	'T-n CaltftCi,6? ?	'?*?	~	*
!	it 1 Type v ?	Circa	(10	'year-date range)
1	?? ?	\	t	9
j (3.)/ NAME OR SUBJECT, rrnceo'k	Mf_______________
--I ^tate fname in full (if known)
RECORD REQUEST	jWfk
1	!	!	! -	Type	- 1 u	Circa	(1G	yeah	date	range)!
/	i	!	J	1	I	_
'VFAME OR SUBJECT	~	I__________"	__________
*	State name in full (if known)
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REQORD REQUEST d?frTh	____________//ff ' Ot&iA*
1	5	Type	'	!	Circa	(10 year cate ;rarid;e')1 \
\A	a	J-	jLIajlj	j	f/j	J
^ADDITIONAL INFORMATION 0c-fooC.	________________	y___________________
Kbrnb>-&v?\u. IjLi4.?ijuji ,	jj&lcviA	<yA^	(3	^
------------------------1-----------------------------------------------.___________________________ .
Use reverse side if necessary and check (	)
Signature	?Jf^Qau&vO
Name	\SJjuQ>duL#UL> L&. lOQOS	AMOUNT	ENCLOSED	$	JO-Od
City	'	St.	Zip