P ALLANTE
C ENTER for
ITALIAN
RESEARCH

DOCUMENT SERVICE - ITALY

(Form B): CIVIL RECORDS-Town Unsure But Province Known.

Use this form when you know the name of the province in Italy, but are unsure of the town,

The fee is $250 for this type of request.

*For a birth record search, if you do not know the parents names (including mother's maiden name, You must know the exact full date. Give as much information as you can. Our search will include a selection of 30 most likely towns in that province, based on surname distribution and emigration history.

Circle the type of document needed: (Fill out a separate form for each): BIRTH, MARRIAGE, or DEATH

*(Required) NAME OF PROVINCE: __________________.
(Print clearly): Full Name of Your Ancestor: _____________________________: ___Male ___ Female
Your Ancestor's Spouse: ________________________
Your Ancestor's Parents: (use maiden name for mother)
Father: __________________________
Mother: __________________________(surname of mother before marriage)_________________
**If date and town are both unsure, it is recommended that you do further researchto obtain more information before beginning research in Italy. However, if you want to take a chance and guess, you may choose a range of up to three years to be searched: (From:_____To:_____).

List any and all possible towns you have reason to suspect within the province listed above:
_____________________________, _____________________________, _____________________________

Source of your information:______________________________________________________
(eg. Is it from specific documents you’ve found, family stories, or a calculated guess?)

WHERE SHOULD WE SEND THE RESULTS OF THE SEARCH? (Please print neatly)
Name: ___________________________________
Address: _________________________________
Postal Code: ______________________________
Country: _________________________________
Email: ___________________________________

THANK YOU FOR YOUR ORDER. Please enclose a self-addressed, stamped envelope. Allow about 9 weeks.

PAYMENT METHODS: Personal Check: payable to "Pallante Center". (Outside USA, add $2 for postage & handling)
Credit Card: VISA, Mastercard, American Express, Discover. (Print Clearly!)
Account Number: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Expiration date: (month & year) ___/__
Name on card: __________________________________ Signatue: __________________________________

Paypal.com (Must have existing paypal account to use this method).
Disclaimer:
A request for a *search* will be filed. It cannot be guaranteed that the document will definitely be found. Occassionally some births, marriages, or deaths were never recorded in civil registry books for various reasons, certain registry books have not survived, or have water damage on certain pages. PCIR not responsible for the date or place you choose.

Mail this form to:

Pallante Center for Italian Research
Documents - Italy
P.O. Box 4664
Queensbury, NY 12804 USA