CHICAGO GENEALOGICAL SOCIETY
ANCESTOR CERTIFICATE APPLICATION
page 1 of 2
(Please PRINT legibly)
| Name of ANCESTOR |
Date |
City / Town / Twp. |
County |
State / Country |
| Born | Place |
| Died | Place |
| Cemetery and Location |
| Married | Place |
| Ancestor's SPOUSE (maiden name) |
| Born | Place |
| Died | Place |
| Cemetery and Location |
| DATE Ancestor settled in Chicago / Cook County |
| Location |
| Name of Ancestor's FATHER |
| Name of Ancestor's MOTHER |
| CHILDREN of Ancestor (use separate sheet if necessary) |
Name |
Born |
Where |
Died |
Where |
| To the best of my knowledge the above information is correct. I understand that all materials submitted become |
| the property of the Chicago Genealogical Society, and hereby give my permission to publish the material. |
| Name of APPLICANT |
| Street Address | Phone |
| City | State | Zip |
| E-Mail Address |
| Signature | Date |