Connecticut USGenWeb Archives
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USGenWeb Archives - Connecticut
Record Submission Forms

Documents placed in the USGenWeb Archives remain the property of the contributor,
the contributor gives permission to the USGenWeb Archives to store the file permanently for free access.
See USGenweb Copyright For More Information
These forms are for genealogical and historical records only.
We are not connected to the Social Security Administration in any way.
If you are wanting a Social Security number or need to contact the Social Security Administration please click here.
Please transcribe the full record, if you do not have the full record or all the facts required, please do not use this form.

Please cite the source of your information in the Additional Comments box if there is no box on the form for citing a printed source.
Connecticut USGenWeb Archives Social Security Applications
Click here for information about these forms. (Opens a New Browser)
Use this form to transcribe and send your ancestors Social Security Application to the Connecticut USGenWeb Archives
formatted for acceptance in the USGenWeb Archives Project Or you can send your file by email to the
Archives Manager for your county (Addresses below)
(Fields with an * are required Please double check this before you submit.) Your tab key will work to move between fields.
Your Email Address:    
Your First Name-Submitter: Your Last Name-Submitter:

Applicants Name (First, Middle) Last Name
Name At Birth (First, Middle) Last Name (Maiden)

Gender:   Race
Place Of Residence:  

Date Of Birth:
Month: Day: Year: * 
Place Of Birth: (City, County State)  
Applied for SS number before?:  
Employer name & address:

Mothers Name (First Middle) Mothers Maiden Name

Fathers Name (First Middle) Fathers Last Name

Applicant's signature:  
Date Signed:Month: Day: Year:
Other Information On Record:

Enter Any Additional Comments:

County Where File is to be Posted:

If you want a copy of this sent to your email check here: 

(Before you submit please note, we can not provide you with records, if you are looking for a record please click here.
These forms are for sharing records which you already have in your possession.)

[ Connecticut USGenWeb Archives Table of Contents ]

Connecticut State Archives Manager (All Counties): Debra Crosby - Temporary The Registry

Record Submission Forms For Other States
Record Submission Forms For Other States Mirror Site

Problems or Comments about the forms only contact Debra Crosby The Registry
Created by David Crosby © Copyright 2002 - Present