Calhoun County Pioneer Certificate Application

Instructions: Fill in all blanks to the best of your ability. Print or type all information in black ink, surnames should be in CAPITAL LETTERS. A check or money order for $10.00 (non-refundable) and $5.00 for additional certificates must  accompany the application. Application, copies of proofs and check or money order should be mailed to: 
CCGS–Pioneer Project, P.O. Box 879, Marshall, MI 49068.

A. Applicant’s Name

_____________________________________________________ (as it will appear on the Certificate)

_____________________________________________________ (Street address)

_____________________________________________________ (City, State, Zip)

B. Name of your descendant(s) receiving certificate(s)

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

C. Name of Ancestor _______________________________________________________________________________________
 (name of earliest ancestor who resided in Calhoun County, MI)

Birth _____________________________________ (date/place)

Death____________________________________ (date) (place)

Baptism__________________________________ (date/place)

Buried_____________________________________________________ (date/place)

Married ___________________________________(date/place) by__________________________ (Rev/JP and name)

Married to ______________________________________________________________________ (name)

Birth of Spouse______________________________(date/place)

Death of Spouse_____________________________(date/place)

D. Where in Calhoun County did ancestor settle? ________________________________________________________________
(city, town, village, township)

Emigrated from ____________________________________________________________________
(township) (county) (state, province/country)

Proof of Residency ___________________________________________________________________

Date of Earliest Residency _____________________________________________________________

I understand that this information will be publicly available for future genealogical research.

____________________________________________________
( Signature of applicant ) (date sent)

   ______________________________________________________________________

File Number _________________ Name of Ancestor___________________________________________

Date Received ________________________________  Date Returned, if applicable_____________________________________

Date Completed _______________________________  Date Certificate Issued _________________________________________

Comments:

These forms may be reproduced.

_________________________________________________________________________________________________

1. Ancestor’s Name _________________________________ was born on ______________________________________

at (place) _______________________________ (county) _______________________ (state) ________________________

Died on _________________ Place ____________________________________________________

Married to (spouse) _________________________________________________________________