Certificate Application

Name: Certificate Application
SKU: 4242
Availability: InStock

$15.00 – $25.00

Type

Clear

Applicant Information:

Name *

Email Address: *

Mailing Address: *

Date of Birth: *

Qualifying Ancestor Information:

Name *

Date of Birth:

Place of Birth:

Father's Name:

Mother's Name:

Date of Arrival in Utah: *

Place of Arrival in Utah:

Pioneer Company:

Spouse's Name:

Names of Children:

Date of Marriage:

Place of Marriage:

Subsequent Places of Residence (Utah, other):

Date of Death:

Place of Death:

Place of Burial:

FamilySearch ID#:

Link to Ancestor in FamilySearch Tree:

Short Biographical Sketch: *

Photo Image:

Documentation:

Please provide a proof document for each relationship. A proof document will usually consist of your research and multiple supporting documents that support your research.

Your Parent Name: *

Still Alive:

yes

Proof of Relationship:

Your G-Parent Name:

Still Alive:

yes

Proof of Relationship:

Your GG-Parent Name:

Still Alive:

yes

Proof of Relationship:

GGG-Parent Name:

Proof of Relationship:

GGGG-Parent Name:

Proof of Relationship:

GGGGG-Parent Name:

Proof of Relationship:

GGGGGG-Parent Name:

Proof of Relationship:

GGGGGGG-Parent Name:

Proof of Relationship:

GGGGGGGG-Parent Name:

Proof of Relationship:

Release of Information:

You agree to release the information provided in this application to be published as part of the Utah Genealogical Association’s First Families database. Information about living people will be recorded, but not made public. Your name will be included as the submitter of the application, but no other facts pertaining to living people will be published. If you are under 18, your parent/guardian must provide their consent by adding their name. *

I Agree:

Consenting Parent Name:

Featured in Publications:

If your application is accepted and a certificate is issued, we would like to highlight you and your pioneer ancestor in the Utah Genealogical Association newsletter and/or the Crossroads journal. If you would like to be featured, please provide a photograph and short bio of yourself. If you are under 18, your parent/guardian must provide their consent by adding their name.

Consenting Parent Name:

Short Bio:

Photo Image:

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SKU

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Category:

Uncategorized

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