| Membership Number:___________________ Received:___________________________ |
| Verified:
___________________________
Examined:___________________________ |
| Name of
Applicant: private (Frost) |
| Address:
(private) |
| Name of
Resident: Roger Q. Frost & Mattie Viola (Ola) Mitchell Frost |
Signatures of Craig County Genealogical
society Officers |
| President:____________________________ Secretary:____________________________ |
| Vice President:
______________________ Date:________________________________ |
| SIGNATURE OF APPLICANT:
(Signed Here) |
| |
| I
here by understand that my name may be published as the submitter of this
paper. No personal information of a living person will be released with
out their expressed written consent. |
|
Signature: (Signed here) Date:
(put current date here) |
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