.CERTIFICATE NO: __________ APPLICATIONPIONEER FAMILIES OF FAYETTE COUNTY , TEXASPRIOR TO 1880
FAYETTE COUNTY GENEALOGICAL SOCIETY P. O. Box 5 La Grange, TX 78945
INSTRUCTIONS TO APPLICANT: Fill in blocks A and B on this page. List your main ancestral line on pages 2 and 3, beginning with yourself in #1. Type or hand print in black ink all information. Enter Recipient’s name in Block A exactly as you want it on certificate. If you wish a husband or wife who were ancestors (and who both qualify) listed on the same certificate enter both their names in Block B exactly as you want them to appear on the certificate.
APPROVED BY: Researcher __________________________________Date______________________ Committee Chairperson __________________________________Date______________________ President/Vice President __________________________________Date______________________ I ______________________________________ was born on _____________________ at ___________________________________________________________________ City County State 2. I am the child of _______________________________________________________ born on ________ at ___________________________________________________ City County State died on ________ at ____________________________________________________ City County State and _____________________________________________ (his/her) (wife/husband) born on ________ at ___________________________________________________ City County State died on ________ at ____________________________________________________ City County State married on ________ at _________________________________________________ City County State The said ________________________________________ was the (son/daughter) of 3. _____________________________________________________________________ born on ________ at ___________________________________________________ City County State died on ________ at ____________________________________________________ City County State and _____________________________________________ (his/her) (wife/husband) born on ________ at ___________________________________________________ City County State died on ________ at ____________________________________________________ City County State married on ________ at _________________________________________________ City County State The said ________________________________________ was the (son/daughter) of 4. _____________________________________________________________________ born on ________ at ___________________________________________________ City County State died on ________ at ____________________________________________________ City County State and _____________________________________________ (his/her) (wife/husband) born on ________ at ___________________________________________________ City County State died on ________ at ____________________________________________________ City County State married on ________ at _________________________________________________ City County State The said ________________________________________ was the (son/daughter) of 5. _____________________________________________________________________ born on ________ at ___________________________________________________ City County State died on ________ at ____________________________________________________ City County State and _____________________________________________ (his/her) (wife/husband) born on ________ at ___________________________________________________ City County State died on ________ at ____________________________________________________ City County State married on ________ at _________________________________________________ City County State The said ________________________________________ was the (son/daughter) of 6. _____________________________________________________________________ born on ________ at ___________________________________________________ City County State died on ________ at ____________________________________________________ City County State and _____________________________________________ (his/her) (wife/husband) born on ________ at ___________________________________________________ City County State died on ________ at ____________________________________________________ City County State married on ________ at _________________________________________________ City County State The said ________________________________________ was the (son/daughter) of 7. _____________________________________________________________________ born on ________ at ___________________________________________________ City County State died on ________ at ____________________________________________________ City County State and _____________________________________________ (his/her) (wife/husband) born on ________ at ___________________________________________________ City County State died on ________ at ____________________________________________________ City County State married on ________ at _________________________________________________ City County State SPECIFICATIONS FOR PIONEER FAMILIES OF FAYETTE COUNTYAny person who is a direct descendant of an individual who settled in FAYETTE County , Texason or before December 31, 1880, may become a member on the acceptance of an applicationwith proof of such descent and the payment of the $40.00 fee.INSTRUCTIONS TO APPLICANT: You must submit with your application evidence to support both your descent from the ancestor and the fact that he/she resided in FAYETTE County before the end of 1880. Give volume and page for book references and include a photocopy, or other facsimile copy of the pertinent pages, and of all published or unpublished records used for proof. Do NOT send originals records. Typed, hand printed, or written copies of documents, not certified as “True Copies,” are not acceptable. Materials authored by the applicant or his family will not of themselves be accepted as proof. Information for additional ancestral lines should be given on a separate application. PROOF OF SETTLEMENT IN FAYETTE COUNTY PRIOR TO THE END OF 1880 (Marriage records alone are not acceptable as proof of settlement.) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ PROOF OF DESCENT: (List and include copies as stated above) Each step must be proved. 1. ___________________________________________________________________________ ___________________________________________________________________________ 2. ___________________________________________________________________________ ___________________________________________________________________________ 3. ___________________________________________________________________________ ___________________________________________________________________________ 4. ___________________________________________________________________________ ___________________________________________________________________________ 5. ___________________________________________________________________________ ___________________________________________________________________________ 6. ___________________________________________________________________________ ___________________________________________________________________________
I, ____________________________________________________ do hereby swear that the statements set forth in this application are true to the best of my knowledge and belief. Permission is hereby given for AGS to use information from this application in any future publication. Signature of Applicant _____________________________ Date __________________
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