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Residency Documentation Lookup Request

Please allow the Library two to three weeks to research your request and email you with any documents that were found.

Name (First, Last) *

Email *

Phone Number *

Are you filling this out for yourself or another person? *

Myself

Another Person

Full Legal Name of Affected Person (Do not include nicknames) *

Person’s date of birth *

List any name changes, such as maiden name, alias, etc, that may have been used.

List the full legal name of any spouse.

List other people in the household who might help with documentation.

Residency Information

Individuals are eligible for compensation under RECA if:

They were physically present in an affected area for a period of at least two years after January 1, 1949 before their diagnosis of a specified disease.
Initial leukemia exposure occurred after 20 years of age and the onset of the disease was at least 2 years after the initial exposure.

Full Address (Street Address, Street Address Line 2, City, Zip Code) *

What years did you or the other person live at this address? Do not list years after diagnosis. *

More Detail/Explanation *

RECA also applies to people who went to school or worked in the affected zip codes.

Did you or the person go to school(s) in an affected zip code?

Yes

If yes, list school names and what years you or the person attended.

Did you or the person work in an affected zip code?

Yes

If yes, list the name of the business and what years you or the person worked.

Fields marked with * are required.