APPLICATION FOR PIONEER CERTIFICATE
ELIGIBILITY: Applicant must be a direct descendant of the ‘89er who lived in the unassigned lands in Indian or Oklahoma Territory between April 22, 1889 and September 22, 1891.
FEE: $5.00
TYPE OR PRINT INFORMATION
APPLICANT: ________________________________________________________
(name as it will appear on the certificate) _________________________________________________________ (street address) (city) (state) (zip) NAME OF 89’er: ________________________________________________________ ORIGINAL LOCATION: ____________________________________________________ Date of Birth: ____________________ Place: ___________________ Date of Death: ___________________ Place: ___________________ Date of Marriage: _________________ Place: ___________________ Spouse: _______________________________________________________ (if female give maiden name, if known) Date of Birth: _________________ Place: _____________________ Date of Death: _________________ Place: _____________________ Attach machine copy of proof of arrival or residence in the Unassigned Lands in Oklahoma or Indian Territory and submit to the Logan County Genealogical Society at above address. List sources of proof as to descent by generations. Please number photocopied proofs to correspond to each generation number. 1. _________________________________________________________________ 2. _________________________________________________________________ 3. _________________________________________________________________ 4. _________________________________________________________________ 5. _________________________________________________________________ 6. _________________________________________________________________ 7. _________________________________________________________________ 8. _________________________________________________________________ 9. _________________________________________________________________
LINE OF DESCENT CHART 1. _______________________________ was born on __________________________ Applicant Day Month Year __________________________ ___________________________ County State __________________________ Spouse 2 Child of _____________________ Spouse ___________________________ Born ________________________ Place ____________________________ Married ____________________ Place ____________________________ Died _______________________ Place ____________________________ 3 Child of _____________________ Spouse ___________________________ Born ________________________ Place ____________________________ Married ____________________ Place ____________________________ Died _______________________ Place ____________________________ 4 Child of _____________________ Spouse ___________________________ Born ________________________ Place ____________________________ Married ____________________ Place ____________________________ Died _______________________ Place ____________________________ 5 Child of _____________________ Spouse ___________________________ Born ________________________ Place ____________________________ Married ____________________ Place ____________________________ Died _______________________ Place ____________________________ 6 Child of _____________________ Spouse ___________________________ Born ________________________ Place ____________________________ Married ____________________ Place ____________________________ Died _______________________ Place ____________________________ 7 Child of _____________________ Spouse ___________________________ Born ________________________ Place ____________________________ Married ____________________ Place ____________________________ Died _______________________ Place ____________________________ 8 Child of _____________________ Spouse ___________________________ Born ________________________ Place ____________________________ Married ____________________ Place ____________________________ Died _______________________ Place ____________________________ PERMISSION FOR PUBLICATION RELEASE I hereby state that the material submitted with and in this application may be used in a published book at a later date. I also understand that this material submitted by me may be used by me should I decide to print it at a later date. I give my permission to the Logan County Genealogical Society to use the material submitted and allow it to be edited if necessary. Signature _____________________________________ Date ________________ FOR OFFICE USE ONLY File Number ______________________ Name of 89er ________________________ date received ____________________________________________________________ date certificate mailed to applicant _____________________________________ date application returned for further information ________________________