TAX RECORD ORDER FORM

TAX RECORD ORDER FORM

NAME_______________________________________________________________________

ADDRESS___________________________________________________________________

CITY & STATE_________________________________________________________________

EMAIL_______________________________________________________________________

PHONE_____________________________AMOUNT ENCLOSED______________________

YEAR & NAME OF RECORD_____________________________________________________

ANCESTOR'S NAME______________________________________________PAGE #_______

YEAR & NAME OF RECORD_____________________________________________________

ANCESTOR'S NAME______________________________________________PAGE #_______

YEAR & NAME OF RECORD_____________________________________________________

ANCESTOR'S NAME______________________________________________PAGE #_______

Each 'copy' consists of a photocopy of the left and right sides of the tax record, which fits on an 8½ x 11 inch sheet of paper. The cost of the first 'copy' is $3.00. Two 'copies' for $6.00. Each copy over TWO, please add $1.00 per copy. If you run out of room above, you may add more tax copy requests on the back of this form.

Please send this form with your check or money order payable to:

BCHS, research

123 W Diamond Street

Butler, PA 16001

Please allow 2-3 weeks for receipt of these copies.

Any donation you make in addition to the above charges is tax deductible! Please consider helping the BCHS to continue finding and preserving Butler County's rich history.

Thank You for your support!