Marathon County
Genealogical Society
HERITAGE CERTIFICATE
APPLICATION
PRINT OR TYPE ALL ENTRIES -
ALLOW 6 - 8 WEEKS FOR PROCESSING
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Application for Pioneer ˜ Early Settler Century Certificate NAME OF APPLICANT _________________________________________________ Address____________________________________________________________ City_________________________ State________ Zip________ -
_________ TO WHOM IS CERTIFICATE TO BE ISSUED? Enter name exactly as it
is to appear on the Certificate: __________________________________________ Address
_________________________________________________ City
________________________ State __________
Zip _________ - _______ ___________________________________________________________________ TO WHOM IS CERTIFICATE TO BE MAILED? ˜
Applicant ˜
Person to whom issued ___________________________________________________________________ HERITAGE ANCESTOR (Enter name exactly as it is to appear): ___________________________________________________________________ Date of
Birth__________________Place___________________________________ Date of
Death_________________Place___________________________________ Date of Marriage_______________Place___________________________________ Place of
Burial________________________________________________________ When did he/she settle in
Marathon County? __________________________________ Where?
Township/Municipality______________________________________ SPOUSE OF
ANCESTOR__________________________________________________________ Date of
Birth_________________ Place____________________________________ Date of
Death_________________Place____________________________________ Did spouse accompany
Heritage Ancestor when he/she settled in Marathon County? ___________ If Yes, do you want spouse
named on certificate? ______________ PROOF (List all documents submitted to prove settlement
and descent): |
Reserved for Office Use Contact #____________ Accession #__________ Date Rec’d __________ Amt. Rec’d _________ Check # _____________ Prev. Cont. # _________ Date of Cert __________ Director______________ Date Mailed __________ |
Mail to: MCGS, P. O. Box 1512, Wausau, WI 54402-1512
Website: www.geocities.com/mcgsociety
(OVER)
CHILDREN OF
HERITAGE ANCESTOR (List all children. If there are children from more than one
marriage, separate those of each marriage by entering “Children from marriage
with _______” before each grouping.)
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NAME |
DATE & PLACE
OF BIRTH |
DATE & PLACE
OF DEATH |
DATE MARRIED |
NAME OF SPOUSE |
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REMARKS/EXPLANATIONS: |
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I
hereby authorize Marathon County Genealogical Society to publish and/or
release data from this application including the pedigree chart and other
supporting documents. Signature:
Date: Copyright
ã 2001-2004.
Marathon County Genealogical Society. |