Gratiot County Historical & Genealogical Society
Pioneer Certificate Request

Name of ancestor to appear on the certificate:

Submitter's Information

 
Phone  
Address  
Email  

Applicant's Information (leave blank if same as above)

 
Phone  
Address  
Email  

Ancestor Information

Ancestor Name  
Date and Place of Birth  
Date and Place of Death  
     
Spouse Name  
Date and Place of Birth  
     
Date of settlement in Gratiot County  
Place of settlement in Gratiot County  
Place from which ancestor came (if known)  
Proof of arrival description  

Lineage Chart (if using family tree software, please attach your lineage report to this form)

Generation 1   My Gratiot County Pioneer ancestor was
    He/She was born at
    Married to
    Sources:
Generation 2   Their child was my
    He/She was born at
    Married to
    Sources:
Generation 3   Their child was my
    He/She was born at
    Married to
    Sources:
Generation 4   Their child was my
    He/She was born at
    Married to
    Sources:
Generation 5   Their child was my
    He/She was born at
    Married to
    Sources:
     

Please use the button to print this form and mail it to:

Gratiot County Historical & Genealogical Society
PO Box 73
Ithaca, MI 48847