G-1041-2016Fee Rule-83C-FRM-09062016

G1041-TOC-2016Fee Rule-83C-FRM-09062016.docx

Genealogy Index Search Request and Genealogy Records Request

G-1041-2016Fee Rule-83C-FRM-09062016

OMB: 1615-0096

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TABLE OF CHANGES – FORM

Form G-1041, Genealogy Index Search Request

OMB Number: 1615-0096

Date: 10/01/2016


Reason for Revision: Updates are required for Form G-1041 due to a Fee Increase.




Current Page Number and Section

Current Text

Proposed Text

Page 1,

Information About You (Requestor)


Requestor’s Certification


By my signature, I consent to pay all costs incurred for search, duplication, and review of documents up to $20. (See Form G-1041 Instructions for more information).


6.a. Requestor’s Signature


6.b. Date of Signature (mm/dd/yyyy)



Requestor’s Certification


By my signature, I consent to pay all costs incurred for search, duplication, and review of documents up to $65. (See Form G-1041 Instructions for more information).


6.a. Requestor’s Signature


6.b. Date of Signature (mm/dd/yyyy)





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