TRACING BUSINESS, FAMILY & ORGANIZATION HISTORIES
NAME:
________________________________________________ CALLED NAME:
_____________________
NAME OF BUSINESS:
________________________________________________________________________
OCCUPATION TITLE:_______________________________________
_____ CURRENT _____ RETIRED
BUSINESS ADDRESS:
________________________________________________________________________
CITY: _________________________________________________
STATE: _______ ZIP: ______________
OFFICE PHONE: _____________ FAX: _____________
E-MAIL: _________________________________
HOME ADDRESS:
___________________________________________________________________________
CITY: _________________________________________________
STATE: _______ ZIP: ______________
HOME PHONE: _____________ FAX: _____________
E-MAIL: __________________________________
FAMILY NAME(S) of earliest arrivals, with full name, year, relationship:
CURRENT OMAHA RESIDENTS:
BUSINESS HISTORY/FAMILY STORIES AND MEMORIES
□
I have photographs or documents that may be of
interest to the Douglas County Historical Society.
□
You may use my name, information or photographs in
historical publications or programs connected with the Douglas County Historical
Society.
□
Please contact me regarding other recognition
programs.
_______________________
________________________________________________
Date
Signature
Please return to:
Betty J.
Davis, APR, Executive Director
Douglas County Historical Society
Historic Fort Omaha
5730 North 30th Street, #11B
Omaha, NE 68111-1657
Phone: (402) 455-9990; FAX (402) 453-9448
director@omahahistory.org