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Registration Application for the
Anoka County Early Settler Certificate Date____________________________________
______________________________________________________________________________
Name
of Ancestor who settled in Anoka County between 1877-1900. Date settled in Anoka County_______________________________________________________
Born in __________________________________ on___________________________________
Died in ___________________________________on___________________________________
Spouse________________________________________________________________________ Please attach supporting documentation showing proof of residence in Anoka County between 1877-1900, 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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