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FAMILY TREE
Cross Out Class Children Grandchildren Great Grandchildren
That is Not or or or
Applicable Brothers/Sisters Nieces/Nephews Grandnieces/Grandnephews
________________________
________________________
__________________________ ________________________
___________________________ __________________________
_______________________ __________________________
Decedent __________________________
________________________
_______________________ ___________________________ __________________________ ________________________
Name of Spouse __________________________
__________________________
____Deceased___________
Date
________________________
____Divorced___________ ___________________________ __________________________ ________________________
Date __________________________
__________________________ ________________________
____Never Married ________________________
________________________
__________________________
___________________________ __________________________
__________________________ ________________________
________________________
__________________________
___________________________ __________________________
__________________________ ________________________
________________________
________________________
STATE OF NEW YORK
COUNTY OF
____________________________ being duly sworn, states that the charts contained on this paper are correct.
________________________________________
Sworn to me on _______________________
____________________________________
NOTARY PUBLIC NOTE: Complete reverse side of family tree form also
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