KCGS Pioneer Certificate Application


413 N. Main St., Suites L&M
ELLENSBURG, WA 98926-3183

Instructions to Applicants: See eligibility web page for details of eligibility, instructions, and lists of acceptable documentation. Fill in all blanks. Print out this page and type or print in ink all information. A check or money order for $10.00 must accompany each application.

A.  Applicant's name                                                 For KCGS use only
                                                                     File #_________________
    ________________________________________________________         Ancestor_______________
    (as it is to appear on the certificate)                          Date Rec'd_____________
    ________________________________________________________         Date Ret'd_____________
    (street address)                                                   (for further data)
    ________________________________________________________         Date Completed_________
    (city, state)                                                    Date Certificate
B.  Name of Qualifying Ancestor                                      Ck#____________________
    (as it is to appear on the certificate)
    Birth date and place ______________________________________________________________________

    Father's Name_________________________________ Mother's Name ______________________________

    Date when arrived in Kittitas County ______________________________________________________

    Spouse's Name _____________________________________________________________________________

    Date and Place of Marriage_________________________________________________________________

    Emigrated from (if known)__________________________________________________________________

    Place of Residence in Kittitas County______________________________________________________

    Death date and place ______________________________________________________________________
Be sure to enclose a pedigree chart (also called an Ancestral Chart) showing the descent of the applicant from the Pioneer ancestor. Below, give the names of each generation from the Pioneer. Proof must be submitted for arrival in Kittitas county and for each generation. Documents may include Church records, birth, marriage and death certificates, census records, and the like. Do NOT send originals as all copies become the property of KCGS. You are invited to submit a short sketch (no more than 5 pages) of your ancestor's life.
1.  Self __________________________________________________________________
    Type of proof____________________________

2.  Parent_________________________________________________________________
    Type of proof____________________________

3.  Grandparent____________________________________________________________
    Type of proof____________________________

4.  Great-grandparent______________________________________________________
    Type of proof____________________________

5.  Great-great-grandparent________________________________________________
    Type of proof____________________________

6.  Third-great-grandparent________________________________________________
    Type of proof____________________________

7.  Fourth-great-grandparent_______________________________________________
    Type of proof____________________________

8.  Fifth-great-grandparent________________________________________________
    Type of proof____________________________

Remember that each generation must be proven with adequate documentation.

I certify that the information contained in this application is correct to the best of my
knowledge and release the information to the potential and future publishing efforts
of the Kittitas County Genealogical Society. Signature of Applicant ___________________________________________________ Date of Application_______________________________________________________

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ęKittitas County Genealogical Society 2005