Date of Application____________
Application Fee Enclosed ($10.00)_______Little River County Genealogy Society Dues are paid for current year? ($15.00)_____Application Fee & Dues Must be Paid before application will be processed.You must be a current LRCGS member to apply for a certificate.Check category for which you are applying:Pioneer Families (pre March 5, 1867)_________
Early Settlers (March 6, 1867-January 1, 1901)_______
Name of Applicant _______________________________________________________
Last First
Address ____________________________________________________
State,Zip __________________________________________________
E-Mail __________________________ _________________________
Phone #
Full Name of Spouse_______________________________________
Exact Name of Ancestor as you would like it to appear on certificate (please print) _____________________________________________
Name of Ancestor
Year First Proved in LR Co.
Township
Residence before LR Co.(County/State)
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
A check____ or money order____, payable to LRCGS is enclosed with this application.I understand that my application and all the material submitted will become the property of the Little River County Genealogy Society and I give my permission to LRCGS to publish information from this application at some future date.Signature of Applicant___________________________________
Date___________________________________________
I am applying for a Pioneer/Early Settler Certificate for my direct ancestor ________________________ who lived in what is now Little River County Arkansas, on or before__________________________.
Mail to:Pioneer Families ProjectLittle River County Genealogy SocietyP.O. Box 288Ashdown, Arkansas 71822
