PEDIGREE CHART

                                                                                                                    Chart No. ____

Number 1 on this chart is the same as no. ___ on chart no. ___


                                                                                       8 -----------------------------------------
                                                                                        |BORN:                                ____
                                                                                        |PLACE:
                                                                                        |MARR:
                                             4 -----------------------------------------|PLACE:
                                              |BORN:                                    |DIED:
                                              |PLACE:                                   |PLACE:
                                              |MARR:                                    |
                                              |PLACE:                                  9 -----------------------------------------
                                              |DIED:                                     BORN:                                ____
                                              |PLACE:                                    PLACE:
   2 -----------------------------------------|                                          DIED:
    |BORN:                                    |                                          PLACE:
    |PLACE:                                   |
    |MARR:                                    |                                       10 -----------------------------------------
    |PLACE:                                   |                                         |BORN:                                ____
    |DIED:                                    |                                         |PLACE:
    |PLACE:                                   |                                         |MARR:
    |                                        5 -----------------------------------------|PLACE:
    |                                          BORN:                                    |DIED:
    |                                          PLACE:                                   |PLACE:
    |                                          DIED:                                    |
    |                                          PLACE:                                 11 -----------------------------------------
1 -----------------------------------------                                              BORN:                                ____
    | BORN:                                                                              PLACE:
    | PLACE:                                                                             DIED:
    | MARR:                                                                              PLACE:
    | PLACE:
    | DIED:                                                                           12 -----------------------------------------
    | PLACE:                                                                            |BORN:                                ____
    |-----------------------------------------                                          |PLACE:
    | Spouse                                                                            |MARR:
    |                                        6 -----------------------------------------|PLACE:
    |                                         |BORN:                                    |DIED:
    |                                         |PLACE:                                   |PLACE:
    |                                         |MARR:                                    |
    |                                         |PLACE:                                 13 -----------------------------------------
    |                                         |DIED:                                     BORN:                                ____
    |                                         |PLACE:                                    PLACE:
   3 -----------------------------------------|                                          DIED:
     BORN:                                    |                                          PLACE:
     PLACE:                                   |
     DIED:                                    |                                       14 -----------------------------------------
     PLACE:                                   |                                         |BORN:                                ____
                                              |                                         |PLACE:
                                              |                                         |MARR:
                                             7 -----------------------------------------|PLACE:
                                               BORN:                                    |DIED:
                                               PLACE:                                   |PLACE:
Name and address of submitter:                 DIED:                                    |
                                               PLACE:                                 15 -----------------------------------------
                                                                                         BORN:                                ____
                                                                                         PLACE:
                                                                                         DIED:
Phone:                                                                                   PLACE: