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PLEASE PRINT LEGIBLY:
Generation 1 (Pioneer Ancestor):
Generation 2 (Child):  was my: 
Born: Where:
Died: Where:
Married: Where:
Spouse (maiden name): 
Generation 3 (Child): was my:
Born: Where:
Died: Where:
Married: Where:
Spouse (maiden name):
Generation 4 (Child): was my:
Born: Where:
Died: Where:
Married: Where:
Spouse (maiden name):
Generation 5 (Child): was my:
Born: Where:
Died: Where:
Married: Where:
Spouse (maiden name):

Please submit documentation for all information with a check for $5.00 USD to:
Chicago Genealogical Society, Attn: Pioneer Certificate, P.O. Box 1160, Chicago, IL 60690-11603 


This page was updated on 04/28/02.

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2002 Chicago Genealogical Society