|Instructions to applicant: Fill in
all blanks, beginning with yourself as #1. Type or print all information.
A check or money order for $10.00 must accompany each application.
1. Applicant's Name: __________________________________
|FOR MSGS USE ONLY:
(date) (place) (date) (place)
3. Where in Montana did ancestor first appear:? _______________________________________
(city, town, village, county)
When? __________________ Emigrated from____________________________________
(date) (town, county, state, province, country)
RELEASE FORM: Permission is granted by me to use materials I have
submitted for a future publication by the Montana State Genealogical Society,
honoring our Montana ancestors. I ___do or ____don't have a photograph
of my ancestor to share for the publication.
Signature of certificate applicant
Please_____mail, or ________hold for presentation at the next annual MSGS Conference.