ELIGIBILITY: Applicant must be a direct descendant of the ‘89er who lived in the unassigned lands in Indian or Oklahoma Territory between April 22, 1889 and September 22, 1891.

FEE: $5.00

TYPE OR PRINT INFORMATION

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APPLICANT: ________________________________________________________
(name as it will appear on the certificate)

___________________________________________________________________
(street address)
___________________________________________________________________
(city)(state)(zip)

NAME OF 89’er:  ________________________________________________________

ORIGINAL LOCATION:  ____________________________________________________

Date of Birth:  ____________________Place: _______________________________________

Date of Death:  ___________________Place: _______________________________________

Date of Marriage:  _________________Place: _______________________________________

Spouse:  _______________________________________________________
(if female give maiden name, if known)

Date of Birth:  ____________________Place: _______________________________________

Date of Death:  ___________________Place: _______________________________________

Attach machine copy of proof of arrival or residence in the Unassigned Lands in Oklahoma or Indian Territory and submit to the Logan County Genealogical Society at above address. List sources of proof as to descent by generations.  Please number photocopied proofs to correspond to each generation number.

1.  _________________________________________________________________

2.  _________________________________________________________________

3.  _________________________________________________________________

4.  _________________________________________________________________

5.  _________________________________________________________________

6.  _________________________________________________________________

7.  _________________________________________________________________

8.  _________________________________________________________________

9.  _________________________________________________________________

LINE OF DESCENT CHART

1. ____________________________________ was born on _______________________________
   ApplicantDay/Month/Year
   
   __________________________ ___________________________
   CountyState
   
   ____________________________________________
   Spouse


2. Child of: ________________________________ Spouse: _____________________________________
   
   Born: ___________________________________ Place: _______________________________________
   
   Married: ________________________________ Place: _______________________________________
   
   Died: ____________________________________ Place: _______________________________________


3. Child of: ________________________________ Spouse: _____________________________________
   
   Born: ___________________________________ Place: _______________________________________
   
   Married: ________________________________ Place: _______________________________________
   
   Died: ____________________________________ Place: _______________________________________



4. Child of: ________________________________ Spouse: _____________________________________
   
   Born: ___________________________________ Place: _______________________________________
   
   Married: ________________________________ Place: _______________________________________
   
   Died: ____________________________________ Place: _______________________________________



5. Child of: ________________________________ Spouse: _____________________________________
   
   Born: ___________________________________ Place: _______________________________________
   
   Married: ________________________________ Place: _______________________________________
   
   Died: ____________________________________ Place: _______________________________________


6. Child of: ________________________________ Spouse: _____________________________________
   
   Born: ___________________________________ Place: _______________________________________
   
   Married: ________________________________ Place: _______________________________________
   
   Died: ____________________________________ Place: _______________________________________


7. Child of: ________________________________ Spouse: _____________________________________
   
   Born: ___________________________________ Place: _______________________________________
   
   Married: ________________________________ Place: _______________________________________
   
   Died: ____________________________________ Place: _______________________________________


8. Child of: ________________________________ Spouse: _____________________________________
   
   Born: ___________________________________ Place: _______________________________________
   
   Married: ________________________________ Place: _______________________________________
   
   Died: ____________________________________ Place: _______________________________________

PERMISSION FOR PUBLICATION RELEASE

I hereby state that the material submitted with and in this application may  be used in a published book at a later date.  I also understand that this  material submitted by me may be used by me should I decide to print it at  a later date.  I give my permission to the Logan County Genealogical  Society to use the material submitted and allow it to be edited if  necessary.

Signature: _____________________________________ Date: ________________

FOR OFFICE USE ONLY

File Number ______________________  Name of 89er  ________________________

date received  ____________________________________________________________

date certificate mailed to applicant  _____________________________________

date application returned for further information  ________________________