Application for
1. Name of Pioneer (as it will appear on certificate)
___________________________________________________________________
date of birth __________________ place of
birth __________________________
date of marriage _______________ place of marriage
_______________________
date of death _________________ place of
death __________________________
spouse’s name
________________________________________________________
earliest date in Scott County
_____________________________________________
Line of descendant: please fill in as many names as
necessary
to show generations
from pioneer to the descendant named on Certificate. Add a page,
if needed.
2. Their child :
______________________________________________________
date of birth ____________________ place of
birth _______________________
spouse ‘s name
_____________________________________________________
3. Their child:
_______________________________________________________
date of birth _____________________
place of birth _______________________
date of marriage _________________ place of marriage
____________________
date of death ____________________ place of death
_______________________
spouse’s name
_______________________________________________________
4. Their child:
_______________________________________________________
date of birth _____________________
place of birth _______________________
date of marriage __________________ place of
marriage ___________________
date of death _____________________ place of death
______________________
spouse’s name
______________________________________________________
I certify that the statements made in this application are true,
to
the best of my
knowledge. I understand that the application and its
attachments become the property
of Scott County Genealogical Society, and may be used for any
lawful purpose,
including display, reproduction, or publication.
Name of descendant (as it will appear on certificate)
_____________________________
Signature of APPLICANT ___________________________________ date
________
street/post office box
_________________________________________________
town and zip code
____________________________________________________
email address, if available
_________________________________
You may purchase the
certificate for a person who is not related to you.
(Documented evidence should accompany the
application.
Each person (including
the applicant) on the lineage chart should be proved as the
child
of the
preceding generation. Do not send original documents. Please
submit copies only,
as all applications and verifying material will become the
property
of the
Scott County Genealogical Society. Please, write the
generation
number on
each photocopy that pertains to that generation.
For instance, if a newspaper clipping mentions generation #2,
write
2 on that copy.
If the clipping also shows generation #1, also write 1 on the
same
copy.
To prove that my ancestor was in Scott County, Kansas, and that I
descend from this ancestor, I am including the following documentations :
Generation 1.
Generation 2.
Generation 3.
Generation 4.
Generation 5.
Generation 6.
Generation 7.
Please attach another sheet, if necessary.
Examples of sources of proof
(SEND COPIES ONLY – items will not be returned):
Include dates of newspapers, etc.
census records
obituaries
county histories
birth, marriage, death records
newspaper clippings
baptism, church records
land records
plat maps, with owners listed
military records
tombstone inscriptions –give location of cemetery
military records
estate records
school papers
family letters or diaries
voter registration
city directories
immigration
naturalization
You may submit additional information about the pioneer
ancestor if you wish.
Consider including a short narrative of the highlights of
their life in Scott County,
Kansas. A COPY of the pioneer’s photograph would
enhance
the application.
Note: If you are unsure of any dates or information, please use a
question
mark (?) .
Please include the maiden names of all females and full names of
all,
if known.
If your source of information is from a
publication that can’t be sent, please include
the
title, volume, page, location of repository (library, archives,
etc),
or other information
to document each generation.
ELIGIBILITY:
The submitter does not have to be a resident of Scott County,
Kansas.
This application will use about 4 pages when printed.
Fees for each certificate are $10.00. Checks can be made
out
to
Scott County Genealogical Society and mailed with the
application.
For questions and mailing address, please email:
Scott County Genealogical
Society
*please do not write below this line. Thank you*
______________________________________________________________
Application received date: ___________________
Certificate mailed date: _____________________
Certificate number ________________
Approved by pioneer committee member
_________________________________