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Do NOT send this form with your application - this is only a worksheet!
Worksheet Instructions:
Use this form to check and record proof of date/place of settlement and of direct descent.
Entries on this form may be abbreviated or truncated, just as long as you can locate the information again.
Begin with the Pioneer/Early Settler/Century Ancestor. Record date and place of claimed settlement. Correct if necessary. Record the document that proves date and place.
If the application claims spouse accompanied Pioneer/Early Settler/Century Ancestor, record the document that proves that, such as a marriage record, census schedule, etc.
Links in the chain of direct descent go down from the Pioneer/Early Settler/Century Ancestor. Check for proof of every link. It helps to examine the pedigree chart and record the name for each link before checking for proof.
When a link is through a female there will normally be a change in surname, look for proof of marriage, such as a marriage record, obituary, census, etc.
Entries in the Proof column need not be elaborate, just enough so you know what the document is. For example: "1850 census," "Hist of Green Co., p 755," "Obit, Mike Sent," etc.
The comments column is for recording problems with proof. These will usually be the basis for rejecting an application.
If everything is proven, use the bottom section of this form to record information to be entered on the certificate.
Worksheet
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Action
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Name
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Place/Date
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Proof (Document)
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Comments
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Settled in MC
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Spouse accomp
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Link to 1st Gen
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ChangeSurname
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Link to 2nd Gen
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ChangeSurname
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Link to 3rd Gen
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ChangeSurname
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Link to 4th Gen
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ChangeSurname
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Link to 5th Gen
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ChangeSurname
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Link to 6th Gen
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ChangeSurname
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Link to 7th Gen
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ChangeSurname
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INFO FOR CERTIFICATE
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Name(s) of Ancestor(s)
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Township & Year settled
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