Request Form for Genealogy Search

We are offering a Brubacher - Brubaker genealogy search service for you.

The cost will depend on how much research is done; upon contacting us we will let you know how much the cost would be.

Fill in below as much as you can. Send it to us; upon receipt of your check we will research and prepare for you what we find and will return it to you as soon as is practical.

We are glad to be of service to you in aiding you in finding who your ancestors are.
Your full name*
First Middle Last
Give your first, middle, and last name.
Your Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
If married, your spouse's full name
First Middle Last
Married, widowed, or divorced; please enter your most recent information.
Your Father's full name*
First Middle Last
Your Father's date of birth:
MM slash DD slash YYYY
Your Father's date of death:
MM slash DD slash YYYY
Your Mother's full Maiden name*
First Middle Last
Your Mother's date of birth:
MM slash DD slash YYYY
Your Mother's date of death:
MM slash DD slash YYYY
Your Grandparents' names and addresses:
1. Your Father's parents
2. Your Mother's parents
1a. Paternal Grandfather's name
First Middle Last
The name of your Father's father.
Your Grandfather's date of birth:
MM slash DD slash YYYY
Your Grandfather's date of death:
MM slash DD slash YYYY
1b. Paternal Grandmother's Maiden name
First Middle Last
The name of your Father's mother.
Your Grandmother's date of birth:
MM slash DD slash YYYY
Your Grandmother's date of death:
MM slash DD slash YYYY
1c. Do you know where your Father's parents lived?
Address of your Father's parents
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
2a. Maternal Grandfather's name
First Middle Last
The name of your Mother's father.
Your Grandfather's date of birth:
MM slash DD slash YYYY
Your Grandfather's date of death:
MM slash DD slash YYYY
2b. Maternal Grandmother's Maiden name
First Middle Last
The name of your Mother's mother.
Your Grandmother's date of birth:
MM slash DD slash YYYY
Your Grandmother's date of death:
MM slash DD slash YYYY
2c. Do you know where your Mother's parents lived?
Address of your Mother's parents
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do you know anything of your Brubaker/Brubacher Great-Grandparents and where they lived?
Fill in as much as you know; the more, the better.
Great-grandfather's name
First Middle Last
Your Great-grandfather's date of birth:
MM slash DD slash YYYY
Your Great-grandfather's date of death:
MM slash DD slash YYYY
Great-grandmother's maiden name
First Middle Last
Your Great-grandmother's date of birth:
MM slash DD slash YYYY
Your Great-grandmother's date of death:
MM slash DD slash YYYY
Your Great-grandparents' address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
As the Family Historian may have additional questions to aid in research, please give us your email address.
*Please know that we will not give or sell your email address to anyone.
Your Email address*
Enter Email Confirm Email
We will want you to enter your email address a second time to verify that you are not a spammer.
Currently we are not set up to accept online payment for this service. You will need to send a check.

Please make your remittance check payable to:

Brubaker Families of America Family Historian

On the Memo line, please indicate:

Genealogy Research

Mail your remittance check to:

Brubaker Families of America Family Historian
5 Black Walnut Road
Levittown, PA 19057

After making your remittance check out, click on the Submit Button below.

We will begin research for you only upon receiving your remittance check.

Request Form for Genealogy Search

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