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Registration Application

for the

Anoka County Pioneer Certificate

 

                                                                           Date____________________________________

 

 

______________________________________________________________________________

 

Name of Pioneer Ancestor who resided in Anoka County prior to July 1876

 

Date settled in Anoka County_______________________________________________________

 

Born in __________________________________on____________________________________

 

Died in ___________________________________on___________________________________

 

Spouse________________________________________________________________________

 

Please attach supporting documentation showing proof of residence in Anoka County prior to 1876, a completed Family Group Sheet and a Pedigree Chart showing the connection from yourself to the Pioneer Ancestor.

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Name of Applicant_______________________________________________________________

 

Address_______________________________________________________________________

 

Phone ________________________ Email Address ____________________________________

 

I, the applicant, state that the facts set forth in this application are true to the best of my knowledge and belief. I understand that accompanying documents may be made available to the public for research purposes.

 

                                       __________________________________________________(signature)

 

 

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Application received on (date)_______________________________________________________

 

Examined and reviewed by _________________________________________________________

 

 

                                        __________________________________________________________

ACGS President

 

 

Certificate Sent _____________

 

Mail completed forms and $5.00 to :

Anoka County Genealogical Society

2135 - 3rd Ave. North,

Anoka, MN  55303