| Your
Name: ________________________________ |
Your
Pioneer Ancestor: ________________________________ |
|
| Address: ______________________________ | Born: __________________ Died: __________________ | |
| City, State, Zip: _________________________ |
| 1. I, _______________________________________ was born on ________________________________ |
| at __________________________ __________________________ ___________________________ |
| (city) (county) (state) |
| 2. I am the child of ________________________________________________________________ (Father) |
| (first) (middle) (last) |
| born on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| died on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| and _________________________________________________________________________ (Mother) |
| (first) (middle) (last) |
| born on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| died on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| They were married on ___________________ at ____________________________________________ |
| Documents which prove these facts are:_____________________________________________________ |
| ____________________________________________________________________________________ |
| ____________________________________________________________________________________ |
| (Enclose copy of documents with this application) |
| 3. No. 2 was the child of ___________________________________________________________ (Father) |
| (first) (middle) (last) |
| born on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| died on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| and _________________________________________________________________________ (Mother) |
| (first) (middle) (last) |
| born on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| died on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| They were married on ___________________ at ____________________________________________ |
| Documents which prove these facts are:_____________________________________________________ |
| ____________________________________________________________________________________ |
| ____________________________________________________________________________________ |
| (Enclose copy of documents with this application) |
| 4. No. 3 was the child of ___________________________________________________________ (Father) |
| (first) (middle) (last) |
| born on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| died on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| and _________________________________________________________________________ (Mother) |
| (first) (middle) (last) |
| born on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| died on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| They were married on ___________________ at ____________________________________________ |
| Documents which prove these facts are:_____________________________________________________ |
| ____________________________________________________________________________________ |
| ____________________________________________________________________________________ |
| (Enclose copy of documents with this application) |
| 5. No. 4 was the child of ___________________________________________________________ (Father) |
| (first) (middle) (last) |
| born on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| died on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| and _________________________________________________________________________ (Mother) |
| (first) (middle) (last) |
| born on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| died on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| They were married on ___________________ at ____________________________________________ |
| Documents which prove these facts are:_____________________________________________________ |
| ____________________________________________________________________________________ |
| ____________________________________________________________________________________ |
| (Enclose copy of documents with this application) |
| 6. No. 5 was the child of ___________________________________________________________ (Father) |
| (first) (middle) (last) |
| born on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| died on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| and _________________________________________________________________________ (Mother) |
| (first) (middle) (last) |
| born on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| died on ____________________ at ______________________________________________________ |
| (city) (county) (state) |
| They were married on ___________________ at ____________________________________________ |
| Documents which prove these facts are:_____________________________________________________ |
| ____________________________________________________________________________________ |
| ____________________________________________________________________________________ |
| (Enclose copy of documents with this application) |
I, _____________________________, do hereby swear that the statements set forth in this application are true to the best of my knowledge and belief.
Signature: ______________________________ Date: _________________________
|
You found this information at http://www.rootsweb.com /~okleflor/application.htm | ||
| LeFlore Co. OK part of the OKGenWeb Project |
Updated: 11 Oct 2009 Marti Graham, County Coordinator |
Webmaster |