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Do not write in this Space Date Rec'd:_____________________________ Date Issued:____________________________ Cert. No.:______________________________ |
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Application for Gila County Pioneer, Early Settler or Resident Certificate
Purchaser of Certificate:_____________________________________________Phone:__________________
Adress:__________________________________________City:_____________________State:_____Zip:___________________
Type of Certificate: Pioneer____ Early Settler:____Resident: ____
1. Name of applicant ais it is to appear on the certificate:
_________________________________________________________________________________________________________
(Please complete a Pedigree Chart for the Applicant.)
2. Name of Gila County ancestor or resident as it is to appear on the certificate:
_________________________________________________________________________________________________________
a. Relationship to applicant: __________________________________________________________b. Date settled in Gila county:_________________________________________________________
c. Where in Gila County did the person settle? (Name of town settlement, ranch, etc.)
________________________________________________________________________________
d. Source of proof of residency: (Use numbers under 1.c. in Instructions.) _____________________e. Children of Gila County ancestor or resident: (List others on a separate sheet of paper.)
Date Date Date Named: Born: Place: Married: Place; Spouse: Died: Place 1.___________________________________________________________________________________________________
2.___________________________________________________________________________________________________
3.___________________________________________________________________________________________________
4..___________________________________________________________________________________________________
5..___________________________________________________________________________________________________
6..___________________________________________________________________________________________________
7..___________________________________________________________________________________________________
(Please do not write below this line.)
********************************************************************************(Researched by:_________________________________Date:__________________________)
(Verified by:____________________________________ Date:_________________________)
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