File# ________________________________

Ancestor Name ______________________________________________________________

Date Recv'd ________________________________

Date returned for further info ______________________________________________________________

Date completed _______________________________

Date certificate issued ______________________________________________________________

Do not write in above section. For FFCC use only.

First Families of Clayton County

A Pioneer Heritage Organization of Clayton County

Membership & Certificate Application

Instructions: (1)This application form*, (2) the Line of Descent/Proof Document Form  Complete both parts. BOTH parts must be completed and submitted. Please type or print legibly all information. Sign and date the application and consent form. (Applications without signature will NOT be processed.) Send ALL of the above along with photocopies (NO originals, please!!) of your documentation/ proofs and a check or money order in the amount of $35.00 to:

Historical Jonesboro/Clayton County, Inc.

 

PO Box 922 

Jonesboro, Ga.  30237

A. Applicantís name (as you wish it to appear on the certificate):

________________________________________________________________

Street Address:

________________________________________________________________

 

City, State, Zip:

________________________________________________________________

B. Ancestorís Name as it is to appear on the certificate (name of qualifying ancestor who was in Clayton County prior to December 31, 1860):

________________________________________________________________

First date proven to be in Clayton County (REQUIRED):

________________________________________________________________

Birth (date & place):

________________________________________________________________

Baptism (date & place):

________________________________________________________________

Married (date, place, by whom):

________________________________________________________________

Death (date & place):

________________________________________________________________

Burial (date & place):

________________________________________________________________

Spouse (maiden name if known):

________________________________________________________________

Spouse Birth (date & place):

________________________________________________________________

Spouse Death (date & place):

________________________________________________________________

Where in Clayton County did your ancestor live, if known?

________________________________________________________________

*Please give all requested information known about your ancestor. If the information in a specific field above is not known (for example: birth date), please so indicate. Your application will not be rejected for lack of information in any above field with the exception of the first date proven to be in Clayton County field, but including any known information in the other fields will expedite your application.

I am applying for membership in First Families of Clayton County and am submitting the enclosed information for that purpose. I understand and agree that all material submitted to FFCC with this application becomes the property of FFCC and will not be returned. I further grant permission for this material to be published or otherwise disseminated, as FFCC deems appropriate.

Signed _____________________________________ Date _______________

I do ____ do not ____ wish my address ____, telephone number ____ and/or e-mail address ____ to be shared with other researchers of the same surname and/or qualifying ancestor.

I do ____ do not ___ wish to share my information on the internet.

Signed _____________________________________ Date ________________

E-mail Address_____________________________ Telephone____________________

NOTE: applications lacking ANY of the following will not be processed: Signed application, Line of Descent /Proof document Form, $35 check or money order