application3

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3. The said_______________________________was the_____________________________
son or daughter

    of_______________________________________________________________________
    Born on__________________at______________________________________________
                                                                    City                       County                        State

Died on__________________at_______________________________________________
City County State

and________________________________his wife.

Born on__________________at______________________________________________
City County State

Died on__________________at_______________________________________________
City County State

Married on_______________at________________________________________________
City County State

PROOF for #3
___________________________________________________________________________
_____________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

4. The said_______________________________was the_____________________________
son or daughter

Died on__________________at_______________________________________________
City County State

and________________________________his wife.

Born on__________________at______________________________________________
City County State

Died on__________________at_______________________________________________
City County State

Married on_______________at________________________________________________
City County State

PROOF for #4
___________________________________________________________________________
_____________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

5. The said_______________________________was the_____________________________
son or daughter

Died on__________________at_______________________________________________
City County State

and________________________________his wife.

Born on__________________at______________________________________________
City County State

Died on__________________at_______________________________________________
City County State

Married on_______________at________________________________________________
City County State

PROOF for #5
___________________________________________________________________________
_____________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

6. The said_______________________________was the_____________________________
son or daughter

Died on__________________at_______________________________________________
City County State

and________________________________his wife.

Born on__________________at______________________________________________
City County State

Died on__________________at_______________________________________________
City County State

Married on_______________at________________________________________________
City County State

PROOF for #6
___________________________________________________________________________
_____________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

7. The said_______________________________was the_____________________________
son or daughter

Died on__________________at_______________________________________________
City County State

and________________________________his wife.

Born on__________________at______________________________________________
City County State

Died on__________________at_______________________________________________
City County State

Married on_______________at________________________________________________
City County State

PROOF for #7
___________________________________________________________________________
_____________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

8. The said_______________________________was the_____________________________
son or daughter

Died on__________________at_______________________________________________
City County State

and________________________________his wife.

Born on__________________at______________________________________________
City County State

Died on__________________at_______________________________________________
City County State

Married on_______________at________________________________________________
City County State

PROOF for #8
___________________________________________________________________________
_____________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

COMMITTEE USE ONLY - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - -
Seneca County Genealogical Society
PROVED ANCESTORS

1.______________________________________________________________
2.______________________________________________________________
3.______________________________________________________________
4.______________________________________________________________
5.______________________________________________________________

Applicant's Name:__________________________________________________
Date Application recieved____________________________________________
Fee Recieved______________________________________________________
Applicant active member - yes_______ no_________
Acceptance Date____________________________________________________
FFSC No.:_____________________Gold
FFSC No.:_____________________Silver

Approved by:
Committee Chairperson______________________________________date______________
Committee Member_________________________________________date______________
Committee Member_________________________________________date_______________

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