Polish Genealogical Society of Connecticut and the Northeast, Inc.

Include as many Plot Codes on this form as you like. Plot Codes are like such: CTA100 or
May254.

Also include all the data found in the search results:
t   (1) The surname of the person you are requesting, (2) Plot Code (alphanumeric)
            and (3) Locality (state and city).

Example: Mierzejewski (surname), CTA-222 (plot code), Bridgeport, CT (locality)

t The cost is $3 per Plot Code (not per surname or per cemetery).
       All monies received will be used to copy more cemeteries and expand our database.
       Please provide a self-addressed stamped envelope with your request.

You may use the Cemetery Plot Information Request Form below. Please print the form,
fill it out, and mail it to our office, including a check or money order made out to "PGSCTNE Treasurer". Please do not send cash.

           Polish Genealogical Society of Connecticut and the Northeast, Inc.
                                           Cemetery Inscription Request
                                                         8 Lyle Road
                                          New Britain, CT 06053-2104

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Your name:

First Name
Street Address

Last Name
City, State and Zip

Please list Surname, Plot Code, Locality in the box below.

You may use the back of the form, if you like. Just draw an arrow to alert us to the back page.

Please remember to sign your request. _______________________________