First Families - Descendants  Membership Application

 (Please type or print all data.)

               DESCENDANTS OF KENTUCKY PIONEERS

          First Families Through the Cumberland Gap

 Ø  Applicant’s  name:      _____________________________________________________________________________________                         First                                Middle                          Maiden                                      Last   

Ø Address: Street: __________________________________________________________   Apt # ______

o   City: _____________________________________  State: _________________ Zip: ____________

Ø  Ancestor’s name to appear on certificate:______________________________________________________

Ø    Your name as you want it to appear on the certificate ___________________________________________

o   If you have a relative who is a member, please provide name ___________________________________

Ø  Where and when was your ancestor in the area which is now Kentucky?_____________________________

_______________________________________________________________________________________

·         For each generation, beginning with you as generation 1, supply the following Information: Provide documentation connecting each generation to the previous generation.

Gen 1 Applicant’s Full Name: _____________________________________________________________________

1. Birth date: ___________________________  Place: ______________________________________________
2. Married to: ____________________ Date: _________________ Place: _______________________________
3. Birth date: ___________________________  Place: ______________________________________________

Gen 2   My Father’s :Name _______________________________________________________________________

1. Birth date: _________________________ Place:________________________________________________   
2. Died on: _____________________________at: _________________________________________________
3. Married to: _________________________   Date: _________________ Place: ________________________
4. Birth date: _____________ Place:________________ Death date: ____________ Place:________________

Gen 3   __________________________________________ was the Child of: _______________________________

1. His Birth date: ________________________ Place:_______________________________________________
2. Died on: _____________________________at: __________________________________________________
3. Married to: _________________________   Date: _________________ Place: _________________________
4. Birth date: _____________ Place:_____________________ Death date: ____________ Place: ___________

Gen 4   __________________________________________ was the Child of: _______________________________

1. His Birth date: ________________________ Place:_______________________________________________
2. Died on: _____________________________at: __________________________________________________
3. Married to: _________________________   Date: _________________ Place: _________________________
4. Birth date: _____________ Place:_____________________ Death date: ____________ Place: ___________

Gen 5   __________________________________________ was the Child of: _______________________________

1. His Birth date: ________________________ Place:_______________________________________________
2. Died on: _____________________________at: __________________________________________________
3. Married to: _________________________   Date: _________________ Place: _________________________
4. Birth date: _____________ Place:_____________________ Death date: ____________ Place: ___________

Gen 6   __________________________________________ was the Child of: _______________________________

1. His Birth date: ________________________ Place:_______________________________________________
2. Died on: _____________________________at: __________________________________________________
3. Married to: _________________________   Date: _________________ Place: _________________________
4. Birth date: _____________ Place:_____________________ Death date: ____________ Place: ___________

(continued from page 1)

Gen 7   __________________________________________ was the Child of: _______________________________

1. His Birth date: ________________________ Place:_______________________________________________
2. Died on: _____________________________at: __________________________________________________
3. Married to: _________________________   Date: _________________ Place: _________________________
4. Birth date: _____________ Place:_____________________ Death date: ____________ Place: ___________

Gen 8   __________________________________________ was the Child of: _______________________________

1. His Birth date: ________________________ Place:_______________________________________________
2. Died on: _____________________________at: __________________________________________________
3. Married to: _________________________   Date: _________________ Place: _________________________
4. Birth date: _____________ Place:_____________________ Death date: ____________ Place: ___________

Gen 9   __________________________________________ was the Child of: _______________________________

1. His Birth date: ________________________ Place:_______________________________________________
2. Died on: _____________________________at: __________________________________________________
3. Married to: _________________________   Date: _________________ Place: _________________________
4. Birth date: _____________ Place:_____________________ Death date: ____________ Place: ___________

Gen 10   __________________________________________ was the Child of: _______________________________

1. His Birth date: ________________________ Place:______________________________________________
2. Died on: _____________________________at: __________________________________________________
3. Married to: _________________________   Date: _________________ Place: _________________________
4. Birth date: _____________ Place:_____________________ Death date: ____________ Place: ___________

PROOFS:

 Gen 1 _________________________________________________________________________________________

Gen 2 _________________________________________________________________________________________

Gen 3 _________________________________________________________________________________________

Gen 4 _________________________________________________________________________________________

Gen 5 _________________________________________________________________________________________

Gen 6 _________________________________________________________________________________________

Gen 7 _________________________________________________________________________________________

Gen 8 _________________________________________________________________________________________

Gen 9 _________________________________________________________________________________________

Gen 10 ________________________________________________________________________________________

Reminder:  Include proof for each statement given. Proof linking each generation is required. Do not send original
documents.  Photo copies are acceptable. Parts may be underlined, do not use hi lighter on copies of documents.
Include check or money order in the amount of $30.00 for each certificate desired.                                                                                                                                                   

     __________________________________________                   _____________________________
                  Applicant's signature                                                                  Date

 Mail to:        Bell County Historical Society
                      Descendants of Kentucky Pioneers Membership
                      P O Box 1344
                      Middlesboro, KY 40965