Are you a descendant from a PIONEER who lived in CLINTON COUNTY, IOWA before 1850 or 1851-1880? If so, now is the time to order your PIONEER� CERTIFICATE.

��1. Your source of Proof.
��2. Send an Ancestor chart and a 3X5 card for each person named.

��3. Name of Descendant.__________________________________(This name will be on certificate)

��4. Name of PIONEER.______________________________________________

��5. In Clinton County, Iowa before 1850_________ 1851-1880_________________

��6. Date of Birth __________________ Place of Birth_________________________

��7. Name of Father_____________________Name of Mother__________________________

��8. Date of Date___________________Place of Death_____________________________

��9.Cemetery___________________________Where_____________________________________

10. Date of Marriage_________________Place of Marriage_____________________________

11. Full Name of Spouse________________________________________

12. Birth Date of Spouse_____________Place of Birth___________________________________

13. Parents of Spouse(if known)________________________________________________

14. Date of Death of Spouse_______________Place of Death of Spouse_________________
15. Children---Name,����Birth,����Death Dates
����1.___________________________________________________________
����2.___________________________________________________________
����3.___________________________________________________________
����4.___________________________________________________________
List all children: