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Please print and complete this form and mail it to the address listed below. Volunteers will search several standard sources: Herbarz Polski (Niesiecki), Herbarz Polski (Boniecki) and Herbarz Polski (Stupnicki). If these are not helpful, we will consult additional sources in the library of the Polish Museum of America.

Include a check for a $5 (U.S.) donation (PGSA member) or $8 (U.S.) (non-member) per name searched. The donation is used for the costs of supplies, equipment, and materials. If you are not a member, please consider joining the Polish Genealogical Society of America, and taking immediate advantage of membership benefits.

Please note that you are paying for the search; we can not guarantee the results.

Surname Surname variations Clues to Location

Are you a PGSA Member? Yes____ No______ If yes, membership #_________

Amount submitted: $ ______ Please make check out to PGSA.

Email Address:_____________________________________


Address _____________________________________________________


Please send your order (completed form and check) with a Self-Addressed Stamped Envelope to:

984 N. Milwaukee Avenue
Chicago, IL 60642-4101

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