ROOTS


The Genealogy Questionnaire for the Babylonian Jewry Heritage Center on Iraqi Jewish Families

By: Maurice Shohet

Please answer each questionnaire in the language it is written.
You may fill up your personal information or your relative ones if you choose to.
It is recommended that you answer as many questions as you can.

Current Information:

Name: First: ___________ Middle: _____________ Last: _____________
Maiden Name (For married women): ___________________Date of Birth:________________________
Marital Status: S __ M __ D ___ W __ Address: _____________________________________________
City: _______________ State: _________ Country: _________________________Zip: _____________
Phone # (Home): ________________________ (Office):_______________________________________
Fax# (Home): _______________________ E-mail (Home): ____________________________________
Fax# (Office): _______________________ E-mail (Office): ___________________________________
Occupation: ________________________ Title: ____________________________________________
Personal/Family web-site address : _________________________________________________________

Country of Birth:

Iraq: ___ Other: _______________
Name as it was registered in Country of Birth: _______________________________________________
Name: First:_________ Middle:___________ Last:___________ Place of Birth:____________________
Date of Birth: _____________________ Date of Death: ________________________________________
Marital Status: S __ M __ D ___ W __ Address: ______________________________________________
Emigration City:_________________ Via: Air______ Sea ______ Land _______
Date of Immigration: _______________ Legal: _____ Illegal (smuggled): ____

Country Emigrated To:
Israel: _____ Other: ________ First:_____________ Second: _____________Third: ______________
Date of Arrival (Israel): ________ First:__________ Second :_____________Third: ______________
Date of Death: ________________ Country of Death: ______________

Education & Occupation in Iraq or Country of Birth: C - By Choice O- Other

Last Occupation: __________________________ C __ O __ Period (Years):____________________
Previous Occupation: __________________________ C __ O __ Period (Years): ____________________
Education Period (Years): ____________________
Elementary __ Secondary __ High __ Undergraduate__ Graduate __ City: __________Country: ________
Number of School Years _____ Degrees: BA (BS) __ MA (MS) __ Ph.D. (Dr.) __ Other: __________
Graduation Years: BA(BS) ___________MA(MS) __________Ph.D.(Dr.) _________Other:___________
Major: _________________________ Minor: _________________________

Education & Occupation Outside Iraq: C - By Choice O- Other
Please list all the countries that you lived in

Country 1: _____________ Same as in Country of Birth ___ Changed __

Last Occupation: __________________________ C __ O __ Period (Years):____________________
Previous Occupation: __________________________ C __ O __ Period (Years): ____________________
Education Period (Years): ____________________
Elementary __ Secondary __ High __ Undergraduate__ Graduate __ City: __________Country: ________
Number of School Years _____ Degrees: BA (BS) __ MA (MS) __ Ph.D. (Dr.) __ Other: __________
Graduation Years: BA(BS) ___________MA(MS) __________Ph.D.(Dr.) _________Other:___________
Major: _________________________ Minor: _________________________

Country 2: _____________ Same as in Country of Birth ___ Changed __

Last Occupation: __________________________ C __ O __ Period (Years):____________________
Previous Occupation: __________________________ C __ O __ Period (Years): ____________________
Education Period (Years): ____________________
Elementary __ Secondary __ High __ Undergraduate__ Graduate __ City: __________Country: ________
Number of School Years _____ Degrees: B.A. (B.S.) __ M.A. (M.S.) __ Ph.D. (Dr.) __ Other: __________
Graduation Years: BA(BS) ___________MA(MS) __________Ph.D.(Dr.) _________Other ___________
Major: _________________________ Minor: _________________________

Country 3: _____________ Same as in Country of Birth ___ Changed __

Last Occupation: __________________________ C __ O __ Period (Dates):____________________
Previous Occupation: __________________________ C __ O __ Period (Dates): ____________________
Education Period (Dates): ____________________
Elementary __ Secondary __ High __ Undergraduate__ Graduate __ City: __________Country: ________
Number of School Years _____ Degrees: B.A. (B.S.) __ M.A. (M.S.) __ Ph.D. (Dr.) __ Other: ________ Graduation Years: BA(BS) ___________MA(MS) __________Ph.D.(Dr.) _________Other:___________
Major: _________________________ Minor: _________________________

Family Information:

Father:
Name: First _________ Middle ___________ Last ___________ Date of Birth: ____________________
Place of Birth: Last Address: _____________________________________________ City:____________ Country _____________ Area/Koucha Name:_________________ Jewish Quarter (Y/N):___
Date of Death: _______________________
Education: __________________________ Occupation: __________________________
Mother:
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Place of Birth: Last Address: _____________________________________________ City:____________ Country _____________ Area/Koucha Name:_________________ Jewish Quarter (Y/N):___
Date of Death: _______________________
Education: __________________________ Occupation: __________________________

Wife/Husband (W/H):
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Place of Birth: Last Address: _____________________________________________ City: ____________ Country: _____________ Area/Koucha Name:_________________ Jewish Quarter (Y/N): __
Marriage Date: ___________ Marriage Place: __________________ Any Relation to the H/W: _________
Date of Death: _______________________
Education: __________________________ Occupation: __________________________

Second Marriage Wife/Husband (W/H):
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Place of Birth: Last Address: _____________________________________________ City: ____________ Country: _____________ Area/Koucha Name:_________________ Jewish Quarter (Y/N): __
Marriage Date: ___________ Marriage Place: __________________ Any Relation to the H/W: _________
Date of Death: _______________________
Education: __________________________ Occupation: __________________________

Third Marriage Wife/Husband (W/H):
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Place of Birth: Last Address: _____________________________________________ City: ____________ Country: _____________ Area/Koucha Name:_________________ Jewish Quarter (Y/N): __
Marriage Date: ___________ Marriage Place: __________________ Any Relation to the H/W: _________
Date of Death: _______________________
Education: __________________________ Occupation: __________________________

Children:
First Child:
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Sex: M __ F __ Place of Birth: City: _________ Country :___________ Area/Koucha Name:___________
Education: __________________________ Occupation: __________________________

Second Child:
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Sex: M __ F __ Place of Birth: City:__________ Country:___________ Area/Koucha Name:___________
Education: __________________________ Occupation: __________________________

Third Child:
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Sex: M __ F __ Place of Birth: City:__________ Country:___________ Area/Koucha Name:___________
Education: __________________________ Occupation: __________________________

Fourth Child:
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Sex: M __ F __ Place of Birth: City:__________ Country:___________ Area/Koucha Name:___________
Education: __________________________ Occupation: __________________________
(For more children, please fill-up an additional sheet).
Children from Previous Marriages:

First Child:
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Sex: M __ F __ Place of Birth: City:__________ Country:___________ Area/Koucha Name:___________
Date of Death: _______________________
Education: __________________________ Occupation: __________________________

Second Child:
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Sex: M __ F __ Place of Birth: City:__________ Country:___________ Area/Koucha Name:___________
Education: __________________________ Occupation: __________________________


Third Child:
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Sex: M __ F __ Place of Birth: City:__________ Country :__________ Area/Koucha Name:___________
Education: __________________________ Occupation: __________________________

Grandfather:

From the Father's side:
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Place of Birth: Last Address: ________________________City:____________ Country: _____________ Area/Koucha Name:_________________ Jewish Quarter (Y/N): __

From the Mother's side:
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Place of Birth: Last Address: ________________________City:____________ Country:_____________ Area/Koucha Name:_________________ Jewish Quarter (Y/N): __

Grandmother:
From the Father's side:
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Place of Birth: Last Address: _________________________City :___________ Country: _____________ Area/Koucha Name:_________________ Jewish Quarter (Y/N): __

From the Mother's side:
Name: First _________ Middle ___________ Last (Maiden) ___________ Date of Birth:_____________
Place of Birth: Last Address: ________________________ City:____________ Country: _____________ Area/Koucha Name:_________________ Jewish Quarter (Y/N): __


Name of the person filling the questionnaire: _____________________
Date: _______________________
Address: Street :____________________________________________
City: ________________ State: _____________ Country: ___________
Zipcode: ________________
Tel# (Home): ________________ Fax# (Home): _________________
Tel# (Office): ________________ Fax# (Office): _________________
E-mail(Home): __________________E-mail(Office):_________________