Please fill out your name and address:

Name: _______________________________________________________________

Address: ______________________________________________________________

State/Province: ________________________ Zip/Postal Code: ____________________

Telephone: ___________________________E-mail: ____________________________

Please fill out genealogy research as accurately as possible:

Name: ________________________________________________________________

Birth place: ____________________________________________________________

Year, month, day of birth: __________________________Emigration year: ___________

Place of emigration: ______________________________________________________

Destination of emigration: __________________________________________________

Year, month, day of death : _____________ Place of death: ________________________


Extra information about family, other passengers etc.:










Please send this form to: Migranternas Hus, Runemovägen 8, S-822 92 Alfta