Society of Civil War Families of Licking County
Full name of applicant______________________________ Citizen of ______________
Address________________________________________________________________________
Applicant was born in________________________on_____________ Is the son/daughter of
2.________________________________________born in_____________________________
on_________________and died in________________________________on_______________
and__________________________________his wife, born in_________________________
on_________________and died in________________________________on_______________
Married in_____________________________on________________________that the said
___________________________________________was the son / daughter of:
3.________________________________________born in_____________________________
on_________________and died in_______________________________on_______________
and__________________________________his wife, born in_________________________
on_________________and died in_______________________________on_______________
Married in_____________________________on________________________that the said
___________________________________________was the son / daughter of:
4.________________________________________born in_____________________________
on_________________and died in_______________________________on_______________
and__________________________________his wife, born in_________________________
on_________________and died in_______________________________on_______________
Married in_____________________________on________________________that the said
___________________________________________was the son / daughter of:
5.________________________________________born in_____________________________
on_________________and died in_______________________________on_______________
and__________________________________his wife, born in_________________________
on_________________and died in_______________________________on_______________
Married in_____________________________on________________________that the said
___________________________________________was the son / daughter of:
6.________________________________________born in_____________________________
on_________________and died in_______________________________on_______________
and__________________________________his wife, born in_________________________
on_________________and died in_______________________________on_______________
Married in_____________________________on________________________that the said
___________________________________________was the son / daughter of:
7.________________________________________born in_____________________________
on_________________and died in_______________________________on_______________
and__________________________________his wife, born in_________________________
on_________________and died in_______________________________on_______________
Married in_____________________________on________________________that the said
___________________________________________was the son / daughter of:
8.________________________________________born in_____________________________
on_________________and died in_______________________________on_______________
and__________________________________his wife, born in_________________________
on_________________and died in_______________________________on_______________
Married in_____________________________on________________________that the said
___________________________________________was the son / daughter of:
9.________________________________________born in_____________________________
on_________________and died in_______________________________on_______________
and__________________________________his wife, born in_________________________
on_________________and died in_______________________________on_______________
Married in_____________________________on________________________that the said
___________________________________________was the son / daughter of:
Ancestor is (no.__): ____________________________________________________
SERVICE OF ANCESTOR - Give dates and particulars for lineage society qualification.______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
PROOF OF SERVICE - Title, volume, pages, documents, manuscripts, or other proofs.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
CHILDREN OF ANCESTOR - Indicate marriage, if more than one.
Names Date of Birth To whom married
(noting if married more than once)
_______________________________ _____________ _____________________________________________________________ _____________ ______________________________
_______________________________ _____________ ______________________________
_______________________________ _____________ ______________________________
_______________________________ _____________ ______________________________
_______________________________ _____________ ______________________________
_______________________________ _____________ ______________________________
_______________________________ _____________ ______________________________
PROOF OF DESCENT
(title, author, page, Bible record, public records, or other sources)
2nd Generation: ___________________________________________________________
________________________________________________________________________
________________________________________________________________________
3rd Generation: ___________________________________________________________
________________________________________________________________________
________________________________________________________________________
4th Generation: ___________________________________________________________
________________________________________________________________________
________________________________________________________________________
5th Generation: ___________________________________________________________
________________________________________________________________________
________________________________________________________________________
6th Generation: ___________________________________________________________
________________________________________________________________________
________________________________________________________________________
7th Generation :___________________________________________________________
________________________________________________________________________
________________________________________________________________________
8th Generation: ___________________________________________________________
________________________________________________________________________
________________________________________________________________________
9th Generation: ___________________________________________________________
________________________________________________________________________
________________________________________________________________________
I married ______________________________on_____________at_________________
born _____________________ son/ daughter of ________________________________
My children____________________________born___________at_________________
______________________________________born___________at_________________
______________________________________born___________at_________________
______________________________________born___________at_________________
______________________________________born___________at_________________
______________________________________born___________at_________________
Phone__________________Signature________________________Date_____________
Applicants Name:______________________________________
Address______________________________________________
City/State____________________________________________
Phone number ________________________________________
LICKING COUNTY GENEALOGICAL SOCIETY
101 West Main Street
Newark, Ohio 43055
Phone
740-349-7480
