Coles Co. Pioneer Certificate - Application Form

Please TYPE or PRINT neatly

ALWAYS use maiden names of females, or, if unknown, enter UNKNOWN.
 

Generation 1.
My Coles Co. Pioneer ancestor was-________________________________________________
He/She was my______________________________________________________(Relationship)
He/She came to Coles Co. in the year____________, and settled in_________________________
                                                                                                                           (Town or Township)
                                             (Date)                                                         (Location)
He/She was born-___________________, at__________________________________________
Died-____________________________, at___________________________________________
Married-___________________________________________________________(Spouse's name)
on______________________________, at___________________________________________

Generation 2.
Their child was___________________, who was my___________________________________
He/She was born-___________________, at__________________________________________
Died-____________________________, at___________________________________________
Married-___________________________________________________________(Spouse's name)
on______________________________, at___________________________________________

Generation 3.
Their child was___________________, who was my___________________________________
He/She was born-___________________, at__________________________________________
Died-____________________________, at___________________________________________
Married-___________________________________________________________(Spouse's name)
on______________________________, at___________________________________________

Generation 4.
Their child was___________________, who was my___________________________________
He/She was born-___________________, at__________________________________________
Died-____________________________, at___________________________________________
Married-___________________________________________________________(Spouse's name)
on______________________________, at___________________________________________

Generation 5.
Their child was___________________, who was my___________________________________
He/She was born-___________________, at__________________________________________
Died-____________________________, at___________________________________________
Married-___________________________________________________________(Spouse's name)
on______________________________, at___________________________________________