Fill out the form and then use your browser's <print> command to print the form,
or use your browser's <print> command to print a blank form.

ADAMS COUNTY PIONEER DESCENDANTS APPLICATION

Please, type or neatly print. Review the Instructions.
Use the maiden name of a female spouse, unless it's not known.
For dates use day month year, as in: 9 Jun 1830.

  1. My Earliest Adams County Ancestor was .

    He/she came to Adams Co. in and settled in .

    He/she was born on at ;

    Died on at ;

    Was married to

    on at .

  2. Second Generation: Their child was my

    . He/she was born

    on at ;

    Died on at ;

    Was married to

    on at .

  3. Third Generation: Their child was my

    . He/she was born

    on at ;

    Died on at ;

    Was married to

    on at .

  4. Fourth Generation: Their child was my

    . He/she was born

    on at ;

    Died on at ;

    Was married to

    on at .

  5. Fifth Generation: Their child was my

    . He/she was born

    on at ;

    Died on at ;

    Was married to

    on at .

  6. Sixth Generation: Their child was my

    . He/she was born

    on at ;

    Died on at ;

    Was married to

    on at .

  7. Seventh Generation: Their child was my

    . He/she was born

    on at ;

    Died on at ;

    Was married to

    on at .

  8. Eighth Generation: Their child was my

    . He/she was born

    on at ;

    Died on at ;

    Was married to

    on at .

  9. Ninth Generation: Their child was my

    . He/she was born

    on at ;

    Died on at ;

    Was married to

    on at .


Name to appear on the Certificate:

Before mailing, review the Instructions once more. Mail completed applications and copies of evidence to:

Great River Genealogical Society,
c/o Quincy Public Library
526 Jersey Street
Quincy, Illinois 62301-3996

Application submitted by:

PERMISSION RELEASE I hereby give permission to the Great River Genealogical Society to reproduce the material herein submitted for the Adams County Pioneer Descendants for their publications and microfilming project.

Signed this ______________________day of ____________________________, 20_______

Signature_____________________________________________________________________

HOME