Please make your check out to the Eaton Co Historical Commission. The fee should be included with the Eaton County Pioneer Certificate Project forms and mailed to Courthouse Square Association at 100 W. Lawrence Ave., P.O. Box 411, Charlotte, MI 48813-0337.

EATON COUNTY CENTENNIAL FAMILY SURVEY and PIONEER CERTIFICATE APPLICATION
Print or Type all information in black ink, --Surnames should be in Capital Letters. A check or money order of ($10.00) (non-refundable) and ($5.00) for additional certificates must accompany the Application and mail to: Eaton County Pioneer Certificate Project, Eaton County Genealogical Society, Eaton County Historical Courthouse, 100 W. Lawrence Ave., P.O. Box 337, Charlotte, MI 48813-0337. *Note* use a separate form for your Siblings or Children*

Begin with yourself as #1.

1. The Applicant's Name (to Appear on the Certificate):

_____________________________________________Phone:___________________________

Street Address of Applicant_______________________________________________________

City, Town, and State + Zip._______________________________________________________

E-Mail________________________________________________________________________

Researcher's Name if different than Applicant_________________________________________

2. Name of ANCESTOR:

______________________________________________________________________________

(Name of qualifying ancestor who was in Eaton County, Michigan before 1907, as it will appear on the Certificate)

Birth Date________________ Birth Place (city, state, P.O.Box) ___________________________

Baptism Date_____________Baptism Place ___________________________________________

Death Date______________ Death Place______________________________________________

Buried Date______________ Buried Place_____________________________________________

Married Date_____________ Married Place____________________________________________

Spouse__________________________________________________________________________

(Maiden name when applicable)

Spouse Birth Date____________ Spouse Birth Place(city, State, P.O.Box)

__________________________________

Spouse Death Date____________ Spouse Death Place__________________________________

3. Where in Eaton County did the Ancestor settle?

______________________________________________________________________________

(City, town, village, township, region)

4. Emigrated from_______________________________________________________________

(Township, County, State, Province/Country--if known)

5. Proof for above: ______________________________________________________________

6. Prepare a historical overview of the pioneer’s family and life, origins, migrations and early life in Eaton County. This should be an added extra page before the following data

GENERATION CHART

Please print or type clearly (females use maiden name)

Applicant: ___________________________ _____ Spouse:___________________________________

Birth date:_________________________________ Birth date:_________________________________

Birth Place:________________________________ Birth Place:________________________________

Marr.date:_________________________________ Marr.Place:________________________________

Death Date:________________________________ Death Place:_______________________________

Proof of above:_______________________________________________________________________

___________________________________________________________________________________

Parents:___________________________________ Spouse:___________________________________

Birth Date:_________________________________Birth Date:_________________________________

Birth Place:________________________________ Birth Place:________________________________

Marriage Date:_____________________________ Marriage Place:_____________________________

Death Date:________________________________ Death Date:________________________________

Death Place:_______________________________ Death Place:_______________________________

Proof of above:_______________________________________________________________________

____________________________________________________________________________________

Grandparents:______________________________ Spouse:___________________________________

Birth Date:________________________________ Birth Date:_________________________________

Birth Place:________________________________ Birth Place:________________________________

Marr. Date:________________________________ Marr. Place________________________________

Death Date:________________________________ Death Date:________________________________

Death Place:_______________________________ Death Place:________________________________

Proof of above:_______________________________________________________________________

____________________________________________________________________________________

Great-Grandparents:__________________________Spouse:___________________________________

Birth Date:_________________________________ Birth Date:_________________________________

Birth Place:________________________________ Birth Place:________________________________

Marriage Date:_____________________________ Marr. Place:________________________________

Death Date:________________________________ Death Date:________________________________

Death Place:_______________________________ Death Place:________________________________

Proof of above:________________________________________________________________________

____________________________________________________________________________________

Gr.Gr.Grandparents:_________________________ Spouse:____________________________________

Birth Date:_________________________________ Birth Date:_________________________________

Birth Place:________________________________ Birth Place:________________________________

Marriage Date:_____________________________ Marr. Place:________________________________

Death Date:________________________________ Death Date:________________________________

Death Place:________________________________Death Place:_______________________________

Proof of above:_______________________________________________________________________

___________________________________________________________________________________

Gr.Gr.Gr.Grandparents:______________________ Spouse:___________________________________

Birth Date:________________________________ Birth Date:________________________________

Birth Place:________________________________ Birth Place:________________________________

Marriage Date:_____________________________ Marr. Place:________________________________

Death Date:________________________________ Death Date:________________________________

Death Place:________________________________Death Place:_______________________________

Proof of above:_______________________________________________________________________

Gr.Gr.Gr.Gr.Grandparents:______________________Spouse:_______________________________________

Birth Date:___________________________________Birth Date:____________________________________

Birth Place:__________________________________ Birth Place:____________________________________

Marriage Date:________________________________Marr. Place:___________________________________

Death Date:__________________________________ Death Date:___________________________________

Death Place:__________________________________Death Place:___________________________________

Proof of above:_____________________________________________________________________________

*if additional ancestors are needed, you may add them on a separate sheet of paper*

You may make a copy of this Certificate Application as needed for Children or Siblings.

In addition, you are invited to submit further information about your pioneer family, including Biographies, Family Record Sheets, Land Records and Plat maps of each location lived, Newspaper Articles, etc. This does not prohibit you from publishing your own data if you should desire.

Appropriate Privacy Laws or other Publication Restrictions will be followed and adhered to.

The above applicant is responsible for the accuracy, truthfulness and completeness of this survey and application and its proofs and materials.

They have not been reviewed or verified by the EATON COUNTY HISTORICAL COMMISSION or it agents the Eaton Co. Genealogical Society and Courthouse Sq. Inc.

ECHC file; Heritage Award Cert. jhk 4/11/07