Paradise Genealogical Society
Butte County Pioneer Settler Certificate Program
Application, Page 1 of 4
(Please see instruction sheet for directions on filling out these forms)
PLEASE TYPE OR PRINT CLEARLY
Pioneer Settler Information
Name of Pioneer Settler: ___________________________________________________
Date & Place of Birth: _____________________________________________________
Father's Name: _____________________________________________________________
Mother's Maiden Name:_______________________________________________________
Date & Location where Pioneer settled (in what is now Butte Co.):
____________________________________________________________________________
Occupation (if known):______________________________________________________
Date & Place of Death for Pioneer Settler: _________________________________
Location of Burial: ________________________________________________________
(Cemetery name, city, county, state):
Date & Place of Marriage:___________________________________________________
Name of spouse (include Maiden Name if female):_____________________________
Date & Place of Birth for Spouse:___________________________________________
Date & Place of Death for Spouse:___________________________________________
Location of Burial: ________________________________________________________
(Cemetery name, city, county, state):
Recipient
Name of person receiving certificate: ______________________________________
His/her relationship to the Pioneer Settler: _______________________________
Other Children of Pioneer Settler (if known)
Name __________________________________________
Date of Birth & Place_______________________________________________________
Date of Death & Place ______________________________________________________
Name __________________________________________
Date of Birth & Place_______________________________________________________
Date of Death & Place ______________________________________________________
Additional children, if any, may be entered on back.