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:
10.________________________________________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:
11.________________________________________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:
12.________________________________________born in____________________________
on_________________and died in_______________________________on_______________
and__________________________________his wife, born in_________________________
on_________________and died in_______________________________on_______________
Married in_____________________________on________________________.
Ancestor is (no.__): ____________________________________________________
SERVICE OF ANCESTOR - Give dates and particulars for lineage society qualification.
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: ___________________________________________________________
________________________________________________________________________
________________________________________________________________________
10th Generation: __________________________________________________________
________________________________________________________________________
________________________________________________________________________
11th Generation: __________________________________________________________
________________________________________________________________________
________________________________________________________________________
12th Generation: __________________________________________________________
________________________________________________________________________
________________________________________________________________________
I married ______________________________on_____________at_________________
born _____________________ son/ daughter of ________________________________
My children____________________________born___________at_________________
______________________________________born___________at_________________
______________________________________born___________at_________________
______________________________________born___________at_________________
______________________________________born___________at_________________
______________________________________born___________at_________________
BIOGRAPHICAL DATA
(Including education, career, military service, lineage societies, church affiliations,
and other items of interest to your descendants)
Phone__________________Signature________________________Date_____________
Proposer _____________________________ Seconder __________________________
http://www.execpc.com/~drg/apply.html --- --- September 13, 1997 --- --- Comments to DrG@execpc.com.