Type of Establishment:  (Residence, Church, Restaurant, Land, Cemetery, Etc.)

Property Owner(s)' Names:

Other Family Members and Ages:

Street Address:

City:


State:


Zip Code:

County of Location To Be Investigated If Known:

Phone No. If Different From Your Own (Area Code First)


Email Address of Owner(s) If Different From Your Own (If Known)


YOUR Relationship To Owner(s) If You Do Not Own The Property:


Duration of the Activity:


How Long Have You or Owners Lived There?


Any Recent Deaths in The Family Or of Friends & If So, How Long Ago?


Frequency of Activity:


Known History:  (Are You Aware of Any Historical and/or Traumatic Events Attached to the
Location?  If So, Please  Describe:)


Witnesses:  Are There Any Other Witnesses to The Phenomenon That We Could Contact?
If so, please list their names, email addresses, and or Phone Numbers If They Would Be Willing To Speak With Us:


Any Other Comments: