PIONEER LINEAGE
(Please print or type)

     I, _______________________________ hereby apply for membership in the Pioneer Families of Sumner County, Kansas by right of lineal descent from _______________________________ who settled in Sumner County by the year 1900 AD.

     Township __________________ Section __________________ Date (year) ______________

     Came to Sumner County from:___________________________________________________

     Arrival by: Wagon___ Train___ Horseback___ Walking___ Other____________________

     I am the child of:
1. ____________________________born on __________ at ____________________________

     died at ___________________________on __________ buried ________________________

     married to_________________________on __________ at ____________________________

     The said __________________________ was the child of:
2. ____________________________born on __________ at ____________________________

     died at ___________________________on __________ buried _________________________

     married to_________________________on __________ at ____________________________

     The said __________________________ was the child of:
3. ____________________________born on __________ at ____________________________

     died at ___________________________on __________ buried _________________________

     married to_________________________on __________ at ____________________________

     The said __________________________ was the child of:
4. ____________________________born on __________ at ____________________________

     died at ___________________________on __________ buried _________________________

     married to_________________________on __________ at ____________________________

     The said __________________________ was the child of:
5. ____________________________born on __________ at ____________________________

     died at ___________________________on __________ buried_________________________

     married to_________________________on __________ at ____________________________

Signed _____________________________________

Name__________________________________

Street/Route_____________________________

Post Office______________________________

State/ZIP_______________________________

Phone (optional)__________________________

Return to:

Della M. Shafer
181 Western
Haysville, KS 67060
Phone: 316-524-7637
E-mail: dellasha@juno.com