|
Membership Number:___________________ |
Received:_____________________________ |
| Verified:
___________________________ |
Examined:_____________________________ |
|
| Name:________________________________________________________________________ |
| Address:_____________________________________________________________________ |
|
Area of
Resident:____________________________________________________________ |
| Occupation:__________________________________________________________________ |
|
Signature Of Applicant:______________________________________________________ |
|
Date of 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:________________________________ |