Print out the form and mail to the Branch
Genealogical Record of London & Middlesex County Settlers
Volume #
Page #
1. Full name of settler
DD/MM/YY Town/County/Prov or State/Country
Birth Date Place
Marriage Date Place
Death Date Place
Cemetery Place
Times Married . Wife - other(s) name
Settled in town or township of in Middlesex County
Date of Settlement Came from
Next previous residence
Moved from Middlesex County to Date
SETTLER`S PARENTS
2. Father`s Name
Birth Date Place
Marriage Date Place
Death Date Place
Cemetery Place
3. Mother`s Name
Birth Date Place
Marriage Date Place
Death Date Place
Cemetery Place
Other data on parents
WIFE OF SETTLER (OF # 1 ABOVE)
4. Maiden name in full
Birth Date Place
Marriage Date Place
Death Date Place
Cemetery Place
Times married . Name of other husband(s)
Other data on wife
WIFE`S PARENTS
5. Father`s Name
Birth Date Place
Marriage Date Place
Death Date Place
Cemetery Place
6. Mother`s Name
Birth Date Place
Marriage Date Place
Death Date Place
Cemetery Place
Other data on parents
7. Settler`s and/or his wife`s brothers and sisters
-2-
SURNAME
8. Number of children of the settler
Name of child Date Place Born Date Married to whom
Born Married
Other data on children
Education of the settler
Occupation or profession
Military Service
Public offices held
Political Party
Religious affiliation
Lodge or organizations
Residence (lot & con or house # & street)
Other pertinent or interesting information
Sources used for this report
Other known sources
Record completed by
Address
City & Postal Code
Date
Relationship to the Settler
Please return to:
LONDON & MIDDLESEX COUNTY BRANCH OGS
1017 Western Road
Grosvenor lodge
London, Ontario
N6G 1G5
attention - Early Settlers Project