| Membership Number:____________________ |
Received:____________________________ |
| Verified:
____________________________ |
Examined:____________________________ |
|
| Name:________________________________________________________________________ |
| Address:_____________________________________________________________________ |
| Name of Ancestor:____________________________________________________________ |
| Area of Residence:___________________________________________________________ |
| Occupation:__________________________________________________________________ |
| Signature
of Applicant:______________________________________________________ |
|
Date of Application:_________________________________________________________ |
|
| 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:___________________________
Date:_________________________________ |
Signatures of Craig County Genealogical
Society Officers |
| President:____________________________ Secretary:____________________________ |
| Vice President:
______________________ Date:_________________________________ |