Clarke County, Iowa Lineage Certificates

___I am applying for a PIONEER CERTIFICATE -     My Ancestor was in Clarke County by 1856

____I am applying for a SETTLER CERTIFICATE -     My Ancestor was in Clarke County by 1895

Please Type or Print Legibly. Fill in as much information as possible. Don't forget: You must supply proof(s) as outlined on the instruction sheet. Also remember that we will not be returning your documents so send photocopies, not originals. The more information you can send, the more we add to your ancestor's file in the library.

Your Name as you wish it to appear on the Certificate
Clarke Co. Pioneer or Settler Name as you wish it to appear on the Certificate
Date Born	Where
Date Died	Where
Pioneer's Father	Pioneer's Mother
Pioneer's Marriage Date	Where
Pioneer's Spouse
Spouse Date Born	Where
Spouse Date Died	Where
Spouse's Father	Spouse's Mother

Names & Birth Dates of Children (if possible, send family group sheet for the ancestor file):

1.	7.
2.	8.
3.	9.
4.	10.
5.	11.
6.	12.

Year Ancestor settled in Clarke County, Iowa________________ Township, if known

List Sources of Proof which must be included with application (see instructions for acceptable sources):

Mail completed application, Ancestor Chart, all Proofs and Check/ Money Order for $5.00 (plus 6% sales tax) for each application to: