I, __________________________ hereby apply for membership in the Pioneer Families of Sumner County, Kansas
by right of lineal descent from __________________________ who settled in Sumner County by the year 1900 AD.
Township______________________ Section ________________________ Date (year)_________________
Came to Sumner County from:_______________________________________________________________
Arrival by:    Wagon____   Train____   Horseback____    Walking____   Other________________________


I am child of:
1._________________________________born on__________at__________________________________
died at_________________________________on__________buried_______________________________
married to_______________________________on__________at__________________________________

The said _______________________________was the child of:
2.________________________________born on___________at__________________________________
died at_________________________________on__________buried_______________________________
married to_______________________________on__________at__________________________________

The said _______________________________was the child of:
3.________________________________born on___________at_________________________________
died at________________________________on__________buried_______________________________
married to_____________________________on____________at_________________________________

The said _______________________________was the child of:
4.________________________________born on___________at_________________________________
died at________________________________on__________buried_______________________________
married to______________________________on___________at_________________________________

The said _______________________________was the child of:
5.________________________________born on___________at_________________________________
died at________________________________on__________buried_______________________________
married to______________________________on___________at_________________________________

   Signed__________________________________

Name_________________________________                                         Return to:
Street/Route____________________________                                         Sumner County Kansas Historical
Post Office_____________________________                                         & Genealogical Center
State/Zip______________________________                                          P.O. Box 402
Phone (optional)_________________________                                         Wellington Ks, 67152
E-mail (optional)_________________________                                        Email: [email protected]