Generation 6.
Their child was___________________, who was my___________________________________
He/She was born-___________________, at__________________________________________
Died-____________________________, at___________________________________________
Married-___________________________________________________________(Spouse's name)
on______________________________, at___________________________________________

Generation 7.
Their child was___________________, who was my___________________________________
He/She was born-___________________, at__________________________________________
Died-____________________________, at___________________________________________
Married-___________________________________________________________(Spouse's name)
on______________________________, at___________________________________________

Generation 8.
Their child was___________________, who was my___________________________________
He/She was born-___________________, at__________________________________________
Died-____________________________, at___________________________________________
Married-___________________________________________________________(Spouse's name)
on______________________________, at___________________________________________

Generation 9.
Their child was___________________, who was my___________________________________
He/She was born-___________________, at__________________________________________
Died-____________________________, at___________________________________________
Married-___________________________________________________________(Spouse's name)
on______________________________, at___________________________________________

This application is submitted by:_____________________________________________________
                                                                      Name(s) which you want to appear on certificate

                            Mailing address_____________________________________________________
                                                                                (Number & Street-or-PO Box)

                                                        _____________________________________________________
                                                         (City)                                                (State)                                         (Zip+4)

Mail this completed application form, along with your good check for $5.00, payable to Coles County Illinois Genealogical Society, to:

Shirley Nees,
Pioneer Certification Project Chairperson
4 Circle Drive
Charleston, IL 61920-2917

email shirlene@consolidated.net for questions only