~~ Jackson Family Genealogy Form ~~


NOTE: By filling out the form below, you are allowing Edward R. Henderson, Jr. the permission to use this
information in his Jackson Family Tree project that consists of the descendents of John Marion Jackson &
Eliza Matilda Kilgore. This information will not be shared with others except in its direct relationship to this
genealogical project.

When filling out the form below, please supply full names, including wife's maiden name in parenthesis (i.e. -
Mary Jane "Doe" Smith). Also supply full dates (i.e. - mm/dd/yyyy). If additional space is required for a
greater number of children than (5) five, please note their name, gender, and birth date in the "Special Request" area of the form.

Please be as specific as you can be in describing this person's relationship to John & Eliza Jackson, or
as far back on your specific ancestors (i.e. - Your parents, grandparents, etc.) as you know. This will help
insure that your information is placed on the correct "branch" of the Jackson Family Tree!

 

Your First Name:

Your Last Name:

Your Address:

Your City:

Your State:

Your Zip Code:

Your Home Telephone No.:

Your Cell Telephone No.:

Email Address:

Retype Email Address:

Your relationship to John and Eliza Jackson:

Husband:

Date Born: In (City, State, County):

Date Died: In (City, State, County):

Buried: In (City, State, County):

Wife:

Date Born: In (City, State, County):

Date Died: In (City, State, County):

Buried: In (City, State, County):

Marriage Date:

Marriage Location:

Children Gender (M or F) Birth Date

Special Requests:

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