Brookfield Publishing Co.
Lineage Form

For Use By the Old World Hereditary Societies

Part I:
Candidate to Immigrant Ancestor

    The Brookfield Publishing Co. Lineage Form is in two Parts, Part I is to establish descent of a candidate from an immigrant ancestor. Part II is to establish descent of an immigrant ancestor from a qualifying ancestor for a particular Old World Hereditary Society. For candidates establishing descent from an immigrant ancestor with an established lineage, it may not be necessary to submit Part II. When the immigrant is either unknown or doesn't have an established lineage, it will be necessary for a candidate to complete Part II.

Mr./Mrs./Miss                                                                                      

Maiden Name (if applicable)                                                             

Full Address                                                                                        

                                                                                                            

PRESENTS PROOF OF ELIGIBILITY IN RIGHT OF DESCENT FROM

                                                                                                                                                 
(Name of immigrant ancestor from whom eligibility is derived)

who was born in ...................................... on......................., immigrated to ............................

............................on ...................................and died in .................................... on ...................

Details of Immigration, including ship, port and other information: .......................................
................................................................................................................................................................
Authorities for immigration only: ..............................................................................................
................................................................................................................................................................
Applicant further says that the said...........................................................................................
(name of ancestor from whom eligibility is derived) is his or her ancestor mentioned in the foregoing application, and that the statements herein set forth are true to the best of his or her knowledge.

Signature of Applicant ........................................................... Date ..........................................

Form: BPC 1998-1 Copyright 1998 Brookfield Publishing Co.

Please include copies of reference material
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Please include copies of reference material
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If additional space is needed, please photocopy this page and renumber the additional generations.

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