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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. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 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) * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Application received on (date)_______________________________________________________
Examined and reviewed by _________________________________________________________
__________________________________________________________ ACGS President
Certificate Sent _____________
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